Individual quality improvement in acute coronary syndromes: a performance improvement initiative

Crit Pathw Cardiol. 2009 Mar;8(1):43-8. doi: 10.1097/HPC.0b013e3181980f75.


Although treatment guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA) have been published and widely accepted, barriers to the optimal management of patients with acute coronary syndromes (ACS) still exist. Adherence to guidelines has been correlated with improvements in patient outcomes in ACS, including reduced mortality, yet data demonstrate that 25% of opportunities to provide guideline-recommended care are missed. This article describes a performance improvement (PI) initiative designed to address gaps in process-related ACS care and improve patient outcomes. PI is an American Medical Association-approved, standardized continuing medical education format in which physicians can earn up to 20 American Medical Association PRA category 1 credits by completing 2 phases of self-assessment and developing and implementing a PI plan to address self-identified areas in which patient care can be improved. In this ACS PI initiative, physicians will assess their practice using performance measures defined by the 2007 ACC/AHA ST-segment elevation myocardial infarction and unstable angina or non-ST-segment elevation myocardial infarction guideline updates within 3 general benchmark areas: (1) patient risk assessment, (2) initial pharmacologic management, and (3) time-to-treatment (ie, "door-to-needle," "door-to-balloon," and "door-in-door-out" times). After completing a self-assessment and identifying 1 or more areas of improvement, participants can complete educational interventions and access benchmark-specific tools that provide guidance on improving adherence with the ACC/AHA guidelines. This PI initiative supplements other ongoing quality improvement initiatives in ACS, but is unique in that it is the first to use individual physician self-assessment, benchmark-focused continuing medical education, and self-developed PI plans to improve process-related ACS care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / diagnosis*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy*
  • Angioplasty, Balloon, Coronary / standards
  • Angioplasty, Balloon, Coronary / trends
  • Attitude of Health Personnel
  • Benchmarking
  • Clinical Competence*
  • Education, Medical, Continuing
  • Emergency Service, Hospital / standards
  • Emergency Service, Hospital / trends
  • Evidence-Based Medicine
  • Female
  • Guideline Adherence*
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Practice Patterns, Physicians' / trends
  • Risk Assessment
  • Sensitivity and Specificity
  • Survival Analysis


  • Platelet Aggregation Inhibitors