The 30-Year Influence of a Regional Consortium on Quality Improvement in Cardiac Surgery
Alexander Iribarne1, Bruce J Leavitt2, Benjamin M Westbrook3
1Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Insights
The Northern New England Cardiovascular Disease Study Group (NNECDSG) collaboration significantly improved coronary artery bypass grafting (CABG) quality and reduced costs over 30 years. This regional consortium demonstrates the effectiveness of quality improvement initiatives in cardiovascular care.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Quality Improvement
Background:
- Established in 1987, the Northern New England Cardiovascular Disease Study Group (NNECDSG) is a regional consortium focused on enhancing cardiovascular care quality in Maine, New Hampshire, and Vermont.
- The study assesses the 30-year impact of NNECDSG's quality improvement initiatives on coronary artery bypass grafting (CABG) outcomes and costs.
Purpose of the Study:
- To evaluate the longitudinal effects of the NNECDSG on the quality and cost-effectiveness of coronary artery bypass grafting (CABG) procedures.
- To determine the sustained impact of collaborative quality improvement efforts on cardiovascular surgical outcomes over three decades.
Main Methods:
- Retrospective review of 67,942 isolated CABG patients across 5 medical centers from 1987 to 2017.
- Patients were stratified into four distinct time periods to analyze trends before and after the implementation of NNECDSG's quality improvement initiatives.
- Quality improvement initiatives included data feedback, training, process mapping, and site visits.
Main Results:
- A consistent decline in in-hospital mortality from 3.4% to 1.8% was observed, despite an increase in predicted patient risk.
- Significant reductions in in-hospital morbidity, including return to OR for bleeding, acute kidney injury, mediastinitis, and low output failure (P < .001).
- Median length of stay decreased from 7 to 5 days, yielding substantial cost savings, alongside a reduction in red blood cell usage per patient.
Conclusions:
- Collaborative quality improvement initiatives through the NNECDSG have achieved significant and sustained enhancements in CABG quality and cost-effectiveness over 30 years.
- The findings support the value of regional consortia in driving improvements in cardiovascular surgical care quality.
Background:
The Northern New England Cardiovascular Disease Study Group (NNECDSG) was founded in 1987 as a regional consortium to improve cardiovascular quality in Maine, New Hampshire, and Vermont. We sought to assess the longitudinal impact of the NNECDSG on quality and cost of coronary artery bypass grafting (CABG) during the past 30 years.
Methods:
Patients undergoing isolated CABG at 5 medical centers from 1987-2017 were retrospectively reviewed (n = 67,942). They were divided into 4 time periods: 1987-1999 (n = 36,885), 2000-2005 (n = 14,606), 2006-2011(n = 8470), and 2012-2017 (n = 7981). The first period was the time the NNECDSG initiated a series of quality improvement initiatives including data feedback, quality improvement training, process mapping, and site visits.
Results:
Throughout the 4 time intervals, there was a consistent decline in in-hospital mortality, from 3.4% to 1.8% despite an increase in predicted risk of mortality (P < .001), and a significant decline in in-hospital morbidity, including return to the operating room for bleeding, acute kidney injury, mediastinitis, and low output failure (P < .001). Median length of stay decreased from 7 to 5 days (P < .001), which translated into potential savings of $82,722,023. There was a decrease in use of red blood cells from 3.1 units to 2.6 units per patient in the most current time, which translated into potential savings of $1,985,456.
Conclusions:
By using collaborative quality improvement initiatives, the NNECDSG has succeeded in significant, sustained improvements in quality and cost for CABG during the past 30 years. These data support the utility of a regional consortium in improving quality.
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