Quality improvement initiative and its impact on the management of patients with acute myocardial infarction

Background: Wide variation exists in acute myocardial infarction (AMI) management, leading to differences in outcomes. Objective: To assess the impact of the quality improvement initiative on appropriate management of AMI. Design: Prospective patient identification, retrospective medical record review. Patients: All patients with AMI discharged alive (N = 497) from our institution between April 1, 1995, and February 28, 1997. Main Outcome Measure: The effect of quality improvements directed at the patient, nurse, and physician on the adherence to key quality indicators. Results: The quality improvement initiative correlated with more frequent use of reperfusion therapy (98%), and with aspirin use in the emergency department (95%), in ideal eligible patients. Similarly, adherence to discharge quality indicators, including use of aspirin (97%), beta -blockers (94%), angiotensin-converting enzyme inhibitors (90%), and lipid-lowering agents (67%); avoidance of calcium channel blockers (93%); a low-fat diet (96%); smoking cessation counseling (94%); and outpatient rehabilitation referral (70%) was higher, including in the very old (those aged greater than or equal to 80 years) and in women. The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used: discharge aspirin (99% vs 96%; P = .02), beta -blocker (98% vs 91%, P = .002), angiotensin-converting enzyme inhibitor (95% vs 86%; P = .01), and lipid-lowering agent (71% vs 62%; P = .04) use; outpatient rehabilitation (82% vs 63%; P = .001); and documentation of smoking cessation counseling (98% vs 87%; P = .001). Conclusions: Implementation of a quality improvement program was associated with a high adherence to quality-of-care indicators for AMI. Patient-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers.