• Rajendra H Mehta, Cecelia K Montoye, Jessica Faul, Dorothy J Nagle, James Kure, Ethiraj Raj, Peter Fattal, Shiraz Sharrif, Mohamadali Amlani, Hameem U Changezi, Stephen Skorcz, Nancy Bailey, Theresa Bourque, Mary LaTarte, Donna McLean, Suzanne Savoy, Paul Werner, Patricia L Baker, Anthony DeFranco, Kim A Eagle, and American College of Cardiology Guidelines Applied in Practice Steering Committee.
• University of Michigan, Ann Arbor, Michigan 48109, USA.
• J. Am. Coll. Cardiol. 2004 Jun 16; 43 (12): 2166-73.

ObjectivesThis project evaluated if by focusing on process changes and tool use rather than key indicator rates, the use of evidence-based therapies in patients with acute myocardial infarction (AMI) would increase.BackgroundThe use of tools designed to improve quality of care in the American College of Cardiology AMI Guidelines Applied in Practice Pilot Project resulted in improved adherence to evidence-based therapies for patients, but overall, tool use was modest.MethodsThe current project, implemented in five hospitals, was modeled after the previous project, but with greater emphasis on tool use. This allowed early identification of barriers to tool use and strategies to overcome barriers. Main outcome measures were AMI quality indicators in pre-measurement (January 1, 2001 to June 30, 2001) and post-measurement (December 15, 2001 to March 31, 2002) samples.ResultsOne or more tools were used in 93% of patients (standard orders = 82%, and discharge document = 47%). Tool use was associated with significantly higher adherence to most discharge quality indicator rates with increases in aspirin, angiotensin-converting enzyme inhibitors, and smoking cessation and dietary counseling. Patients undergoing coronary artery bypass grafting (CABG) had low rates of discharge indicators. Patients undergoing percutaneous coronary revascularization were more likely to receive evidence-based therapies.ConclusionsThese data validate the results of the pilot project that quality of AMI care can be improved through the use of guideline-based tools. Identifying and overcoming barriers to tool use led to substantially higher rates of tool use. The low rates of adherence to quality indicators in patients undergoing CABG suggest that these patients should be particularly targeted for quality improvement efforts.

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