A statewide quality collaborative for process improvement: internal mammary artery utilization.

Area of Science:

• Cardiovascular Surgery
• Quality Improvement Initiatives
• Health Services Research

Background:

• The Michigan Society of Thoracic and Cardiovascular Surgeons (MSTCVS) Quality Collaborative is a voluntary, surgeon-directed initiative.
• Internal mammary artery (IMA) use in coronary artery bypass grafting (CABG) is a key process measure linked to better patient outcomes.
• This analysis focuses on understanding and improving IMA utilization across Michigan.

Purpose of the Study:

• To review the methodology used by the MSTCVS Quality Collaborative to assess and enhance IMA use.
• To identify and address variations in IMA utilization among Michigan cardiac surgery programs.
• To improve statewide adherence to best practices for IMA grafting during CABG.

Main Methods:

• Data from 29,114 CABG procedures (2005-2008) were collected from Michigan sites.
• Seven programs with IMA use below 90% were identified as low users.
• A state-level improvement plan included quarterly monitoring, rationale documentation for IMA exclusion, educational initiatives, feedback, and site visits.

Main Results:

• Initial IMA utilization varied widely (66.2% to 98.4%).
• The seven low-user programs collectively increased IMA grafting from 82.0% to 92.7% (p < 0.0001).
• Statewide IMA use rose from 91.9% to 95.8% (p < 0.0001), exceeding the national average.

Conclusions:

• The MSTCVS Quality Collaborative successfully identified and improved low IMA use rates.
• A surgeon-directed, statewide quality initiative can effectively enhance significant operative processes like IMA grafting.
• These efforts demonstrate the value of collaborative quality improvement in optimizing patient outcomes.