Epidemiologic study, level III.

No abstract

In general, clinicians working in public hospitals use CPG and view them positively. Based on free-text comments, a minority of non-medical respondents perceived guidelines and pathways as interchangeable tools. Improved uptake is dependent on increasing access, enhancing user-friendly guideline presentation, deploying local opinion leaders, and mitigating environmental barriers to implementation.

Objective: To evaluate changes in quality of in‐hospital care of patients with either acute coronary syndromes (ACS) or congestive heart failure (CHF) admitted to hospitals participating in a multisite quality improvement collaboration. Design: Before‐and‐after study of changes in quality indicators measured on representative patient samples between June 2001 and January 2003. Setting: Nine public hospitals in Queensland. Study populations: Consecutive or randomly selected patients admitted to study hospitals during the baseline period (June 2001 to January 2002; n = 807 for ACS, n = 357 for CHF) and post‐intervention period (July 2002 to January 2003; n = 717  for ACS, n = 220 for CHF). Intervention: Provision of comparative baseline feedback at a facilitative workshop combined with hospital‐specific quality‐improvement interventions supported by on‐site quality officers and a central program management group. Main outcome measure: Changes in process‐of‐care indicators between baseline and post‐intervention periods. Results: Compared with baseline, more patients with ACS in the post‐intervention period received therapeutic heparin regimens (84% v 72%; P < 0.001), angiotensin‐converting enzyme inhibitors (64% v 56%; P = 0.02), lipid‐lowering agents (72% v 62%; P < 0.001), early use of coronary angiography (52% v 39%; P < 0.001), in‐hospital cardiac counselling (65% v 43%; P < 0.001), and referral to cardiac rehabilitation (15% v 5%; P < 0.001). The numbers of patients with CHF receiving β‐blockers also increased (52% v 34%; P < 0.001), with fewer patients receiving deleterious agents (13% v 23%; P = 0.04). Same‐cause 30‐day readmission rate decreased from 7.2% to 2.4% (P = 0.02) in patients with CHF. Conclusion: Quality‐improvement interventions conducted as multisite collaborations may improve in‐hospital care of acute cardiac conditions within relatively short time frames.