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A regional collaborative effort for CQI in cardiovascular disease. Northern New England Cardiovascular Study Group
1Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Insights
Collaborative efforts by the Northern New England Cardiovascular Disease Study Group have reduced in-hospital mortality for coronary artery bypass grafting (CABG) surgery through outcome monitoring and quality improvement training.
Area of Science:
- Cardiovascular Surgery
- Quality Improvement Science
- Health Services Research
Background:
- Established in 1987, the Northern New England Cardiovascular Disease Study Group fosters collaboration among institutions to enhance cardiovascular disease patient care.
- Group meetings facilitate explicit discussions on medical decision-making and practice benchmarking.
- Collaboration enables the accumulation of experience to analyze adverse events and implement changes.
Purpose of the Study:
- To investigate the impact of a collaborative quality improvement initiative on cardiovascular disease care, specifically focusing on coronary artery bypass grafting (CABG) procedures.
- To identify common and institution-specific causes of mortality following CABG surgery.
- To implement strategies for reducing adverse events and improving patient outcomes.
Main Methods:
- Instituting a system for monitoring CABG surgery outcomes across all member institutions.
- Providing all members with training in quality improvement tools and techniques.
- Conducting comparative process analysis and benchmarking to identify and share best practices for CABG surgery.
Main Results:
- A decrease in the average in-hospital mortality rate associated with CABG surgery in the region.
- Identification of low output failure as the most common cause of post-CABG death across hospitals.
- Analysis of over 400 deaths to understand the causes of low output failure and inform interventions.
Conclusions:
- Regional clinician leadership and institutional physician champions are key to successful collaborative efforts.
- Timely analysis and confidential return of data allow for examination of current practices.
- An organized forum for data discussion is crucial for learning and implementing improvements.
Background:
The Northern New England Cardiovascular Disease Study Group has met at least three times a year since 1987 to improve the care of patients with cardiovascular disease. ADVANTAGES OF GROUP EFFORT: The group's collaborative nature has allowed members to have explicit discussions about medical decision making and practice and to benchmark with one another. By collaborating, members have been able to accumulate a large enough experience to examine the fine structure of adverse events, learn from them, and institute meaningful changes. IMPROVEMENT STRATEGIES: Focusing on coronary artery bypass grafting (CABG) procedures, the group has used three improvement strategies: (1) Outcomes are monitored across institutions. All members receive reports with information on their experience, their organization's experience, and the regional experience. (2) All members received training in quality improvement tools and techniques. (3) Members conduct comparative process analysis and benchmarking efforts to learn best practices for CABG surgery.
Results:
The average in-hospital mortality associated with CABG surgery in the region has decreased. The group determined that low output failure is the most common cause of post-CABG death across all hospitals, while other causes of death (for example, stroke, bleeding, arrhythmias) have more uneven distributions across hospitals. Individual hospitals have investigated their more unique causes of death; the group as a whole has undertaken a detailed study of more than 400 deaths to determine why patients die of low output failure and what can be done about it.
Keys To Success:
Factors contributing to the group's success include the fact that a regionally recognized clinician spearheaded the effort, and a physician "carries the banner" at each institution; data, which are kept confidential, are analyzed and returned in a timely fashion so group members can examine their current, not just their past, practice; and there is an organized forum for data discussion.