Two studies confirm value of quality improvement
Two major studies recently provided more support to the work done every day by peer review and quality professionals at hospitals across the country. Both studies showed that quality improvement significantly and directly improves the quality of patient care. In the first study, Improving Quality Improvement Using Achievable Benchmarks For Physician Feedback, Catarina Kiefe, MD, PhD, and other researchers found that context performance feedback and benchmarking can be effective (JAMA 2001; 285: 2,871-2,879).
They noted that while they are common tools for health care improvement, such feedback and benchmarking rarely are studied in randomized trials. "Achievable benchmarks of care . . . are standards of excellence attained by top performers in a peer group and are easily and reproducibly calculated from existing performance data." Kiefe, et al, conducted a group-randomized controlled trial in December 1996, with follow-up through 1998. The research involved 70 community physicians and 2,978 fee-for-service Medicare patients with diabetes mellitus who were part of the Ambulatory Care Quality Improvement Project in Alabama. Physicians were randomly assigned to receive a multimodal improvement intervention, including chart review and physician-specific feedback or an identical intervention plus achievable benchmark feedback.
To assess how the patient care improved, the researchers measured pre-intervention (1994-1995) against post-intervention (1997-1998) changes in the proportion of patients receiving influenza vaccination; foot examination; and each of three blood tests measuring glucose control, cholesterol level, and triglyceride level, compared between the two groups. The proportion of patients who received influenza vaccine improved between 40% to 58% in the experimental group vs. 40% to 46% in the comparison group. The researchers concluded that use of achievable benchmarks significantly enhances the effectiveness of physician performance feedback in the setting of a multimodal quality improvement intervention.
The second study was Qualitative Study of Increasing Beta-Blocker Use After Myocardial Infarction: Why Do Some Hospitals Succeed? (JAMA 2001; 285:2,604-2,611.) In this research, Elizabeth H. Bradley, PhD, and others studied how performance measurement improvements directly improve the care of patients.
They noted evidence that beta-blockers can reduce mortality in patients with acute myocardial infarction (AMI) and studied how hospitals have initiated performance improvement efforts to increase prescription of beta-blockers at discharge. "Determination of the factors associated with such improvements may provide guidance to hospitals that have been less successful in increasing beta-blocker use," they wrote.
The researchers gathered data from in-depth interviews conducted in March-June 2000 with 45 key physician, nursing, quality management, and administrative participants at eight U.S. hospitals chosen to represent a range of hospital sizes, geographic regions, and changes in beta-blocker use rates between October 1996 and September 1999. The interviews revealed six broad factors that characterized hospital-based improvement efforts: goals of the efforts, administrative support, support among clinicians, design and implementation of improvement initiatives, use of data, and modifying variables.
Hospitals with greater improvements in beta-blocker use over time demonstrated four characteristics not found in hospitals with less or no improvement: shared goals for improvement, substantial administrative support, strong physician leadership advocating beta-blocker use, and use of credible data feedback. "This study provides a context for understanding efforts to improve care in the hospital setting by describing a taxonomy for classifying and evaluating such efforts," they said. "In addition, the study suggests possible elements of successful efforts to increase beta-blocker use for patients with AMI."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content