Abstract
PRIMARY TRACK
Guideline implementation
SECONDARY TRACK
Performance measures/indicators/quality incentives and guidelines
BACKGROUND (INTRODUCTION)
French acute care HCOs have collected data on six mandatory quality indicators (QIs) relating to post-acute phase management of myocardial infarction (MI) for two successive years (2009 and 2010). These QIs were elaborated taking into account European and American guidelines, and clinical practice guidelines provided by the French National Authority for Health.
LEARNING OBJECTIVES (TRAINING GOALS)
To compare 2009 and 2010 QI results in order to assess evolution in quality of post-acute phase management of patients with MI. To analyze variability between HCOs.
METHODS
All acute care HCOs collected retrospective data on 60 random medical records (principal diagnosis: MI). A paired t-test was applied to compare 2009 and 2010 QIs means. Variability between HCOs was analyzed when the paired t-test was significant. QIs with fewer than 30 records were excluded from the analysis (QI3 Level 2 ACE inhibitor at discharge if LVEF < 40% and QI6 Advice on stopping smoking).
RESULTS
In January 2010, 29 HCOs completed data collection (8%); 1580 medical records were analyzed in 2009 and 1517 in 2010. Improvement was significant for 3 QIs (P < 0.05; QI1 Aspirin/clopidogrel at discharge with mean 2009 = 92% and mean 2010 = 96%; QI4 Level 2 Monitoring statin use by lipid lab test with mean 2009 = 10% and mean 2010 = 26%, and QI5 Advice on diet with mean 2009 = 37% and mean 2010 = 51%). There was no significant difference between 2009 and 2010 means for all other QIs (QI2 beta-blocker at discharge, QI3 Level 1 LVEF measurement, and QI4 Level 1 Statin at discharge). In 2010, there was variability between HCOs for QI4 Level 2 and QI5, except for QI1.
DISCUSSION (CONCLUSION)
In spite of these encouraging interim results (full data collection will be completed in March 2010), there is still room for improving management of MI after acute phase. Variability for QI1 will be checked when all HCOs will have performed their 2010 data collection. If results are confirmed, maintenance of QI1 will be discussed with health professionals.
TARGET AUDIENCE(S)
Guideline developer Guideline implementer Developer of guideline-based products Quality improvement manager/facilitator Medical educator Medical providers and executives Allied health professionals Consumers and patients representatives