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Researchers develop new system for identifying successful hospital quality improvements

Preliminary findings from an ongoing 3-year study funded by the Agency for Healthcare Research and Quality (HS10407) show that a new classification system could help hospitals identify areas where they need to improve care and provide them with key information to achieve their quality improvements (QI) goals. Researchers at Yale University's School of Medicine used the administration of beta-blockers (medications that slow the heart rate during and after a heart attack) as an interview topic in developing a QI classification system.

Between October 1996 and September 1999, they interviewed hospital personnel at eight hospitals around the country to learn about efforts undertaken by the hospitals to improve the use of beta-blockers in heart attack patients. The researchers organized the data around six broad factors that characterize hospital-based QI efforts: goals for improvement, administrative support, clinician support, design and implementation style, use of data, and contextual information such as hospital size.

The researchers then ranked the hospitals into "high performing" and "low performing" groups based on their use of beta-blockers. They found that those hospitals more likely to prescribe beta-blockers (high performing) had similar characteristics: solid support from their hospital administration, strong physician leadership, shared goals of improving medical practice, and an effective way of monitoring progress. Generally, these characteristics were not present in the low performing hospitals.

Study findings indicate that information from this system may provide hospitals with concrete guidance to help them plan effective interventions to elevate clinical performance and improve the overall care and outcomes of their patients.

For more information, see "A qualitative study of increasing beta-blocker use after myocardial infarction," by Elizabeth H. Bradley, Ph.D., Eric S. Holmboe, M.D., Jennifer A. Mattera, M.P.H., and others, in the May 23/30, 2001 Journal of the American Medical Association 285(20), pp. 2604-2611.

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