Quality improvement initiative and its impact on the management of patients with acute myocardial infarction

Arch Intern Med. 2000 Nov 13;160(20):3057-62. doi: 10.1001/archinte.160.20.3057.


Background: Wide variation exists in acute myocardial infarction (AMI) management, leading to differences in outcomes.

Objective: To assess the impact of the quality improvement initiative on appropriate management of AMI.

Design: Prospective patient identification, retrospective medical record review.

Patients: All patients with AMI discharged alive (N = 497) from our institution between April 1, 1995, and February 28, 1997.

Main outcome measure: The effect of quality improvements directed at the patient, nurse, and physician on the adherence to key quality indicators.

Results: The quality improvement initiative correlated with more frequent use of reperfusion therapy (98%), and with aspirin use in the emergency department (95%), in ideal eligible patients. Similarly, adherence to discharge quality indicators, including use of aspirin (97%), beta-blockers (94%), angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); smoking cessation counseling (94%); and outpatient rehabilitation referral (70%) was higher, including in the very old (those aged >/=80 years) and in women. The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used: discharge aspirin (99% vs 96%; P =.02), beta-blocker (98% vs 91%; P =.002), angiotensin-converting enzyme inhibitor (95% vs 86%; P =.01), and lipid-lowering agent (71% vs 62%; P =.04) use; outpatient rehabilitation (82% vs 63%; P=.001); and documentation of smoking cessation counseling (98% vs 87%; P =. 001).

Conclusions: Implementation of a quality improvement program was associated with a high adherence to quality-of-care indicators for AMI. Patient-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiology Service, Hospital / standards*
  • Critical Pathways
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Michigan
  • Middle Aged
  • Myocardial Infarction / therapy*
  • Outcome Assessment, Health Care
  • Patient Education as Topic
  • Prospective Studies
  • Retrospective Studies
  • Total Quality Management / organization & administration*