A Regional Intervention to Improve the Hospital Mortality Associated With Coronary Artery Bypass Graft Surgery

Abstract

Objective. —To determine whether an organized intervention including data feedback, training in continuous quality improvement techniques, and site visits to other medical centers could improve the hospital mortality rates associated with coronary artery bypass graft (CABG) surgery. Design. —Regional intervention study. Patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected on CABG patients in Northern New England between July 1, 1987, and July 31, 1993. Setting. —This study included all 23 cardiothoracic surgeons practicing in Maine, New Hampshire, and Vermont during the study period. Patients. —Data were collected on 15 095 consecutive patients undergoing isolated CABG procedures in Maine, New Hampshire, and Vermont during the study period. Interventions. —A three-component intervention aimed at reducing CABG mortality was fielded in 1990 and 1991. The interventions included feedback of outcome data, training in continuous quality improvement techniques, and site visits to other medical centers. Main Outcome Measure. —A comparison of the observed and expected hospital mortality rates during the postintervention period. Results. —During the postintervention period, we observed the outcomes for 6488 consecutive cases of CABG surgery. There were 74 fewer deaths than would have been expected. This 24% reduction in the hospital mortality rate was statistically significant (P=.001). This reduction in mortality rate was relatively consistent across patient subgroups and was temporally associated with the interventions. Conclusion. —We conclude that a multi-institutional, regional model for the continuous improvement of surgical care is feasible and effective. This model may have applications in other settings. (JAMA. 1996;275:841-846)