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Quality Improvement: Arterial Grafting Redux, 2010:2019
Chris J Bond1, Milan Milojevic2, Chang He3
1Department of Cardiac Surgery, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan.
Insights
A statewide quality initiative significantly increased the use of multiple arterial grafts in coronary artery bypass grafting (CABG). This approach, involving data sharing and education, improved arterial revascularization rates across the state.
Area of Science:
- Cardiovascular Surgery
- Quality Improvement Science
- Health Services Research
Background:
- Growing evidence supports using multiple arterial conduits for coronary artery bypass grafting (CABG).
- Arterial conduit utilization in the U.S. trails behind many European countries.
- A statewide collaborative approach was implemented to enhance arterial graft use.
Purpose of the Study:
- To describe a statewide collaborative initiative aimed at increasing the utilization of multiple arterial conduits in CABG.
- To assess the impact of this initiative on arterial revascularization rates.
Main Methods:
- Four key metrics for arterial revascularization were developed.
- Data were presented and discussed quarterly in statewide quality collaborative meetings starting January 2016.
- A retrospective review of isolated CABG cases (2012-2019) was conducted to evaluate the initiative's effect.
Main Results:
- Statewide use of multiple arterial grafts rose from 7.4% to 21.7% by 2019 (P < .001).
- Total arterial revascularization increased from 1.9% to 4.4% (P < .001).
- Utilization of both radial artery and bilateral internal thoracic artery grafts saw significant increases.
Conclusions:
- The statewide quality improvement initiative successfully boosted multiple arterial grafting rates.
- Identified barriers will inform future quality improvement efforts.
- This model is transferable to other healthcare domains and regions.
Background:
The evidence base favoring utilization of multiple arterial conduits in coronary artery bypass grafting has strengthened in recent years. Nevertheless, utilization of arterial conduits in the US lags behind that of many European peers. We describe a statewide collaborative based approach to improving utilization.
Methods:
Four metrics of arterial revascularization were devised. These were displayed and discussed at quarterly statewide quality collaborative meetings from January 2016 onwards, integrated with an educational program regarding attendant benefits. We undertook retrospective review of isolated coronary artery bypass grafting statewide from 2012-2019 to assess impact.
Results:
A total of 38,523 cases met inclusion/exclusion criteria. Statewide incidence of multiple arterial grafting increased from 7.4% at baseline to 21.7% in 2019 (P < .001), implementation across hospitals varied widely, ranging from 67.6% to 0.0%. Utilization of total arterial revascularization increased 1.9% to 4.4% (P < .001) between time frames. Utilization of both radial artery and bilateral internal thoracic artery conduit increased significantly from 5.3% to 13.2% (P < .001) and 2.1% to 8.5% (P < .001), respectively; radial artery utilization was significantly higher than bilateral internal thoracic artery for each year (P < .001 for all comparisons).
Conclusions:
Our statewide quality improvement initiative improved rates of utilization of multiple arterial grafting by all metrics. Barriers to current utilization were identified to guide future quality improvement efforts. This reproducible approach is readily transferable to improve quality of care in other domains and geographical areas.
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