Clinical studyThe results of a randomized trial of a quality improvement intervention in the care of patients with heart failure☆
Section snippets
Hospitals
The design of the Management to Improve Survival in Congestive Heart Failure (MISCHF) Study has been reported (12). In brief, 10 acute care community hospitals in upstate New York participated in this trial. None offered programs of tertiary care, such as cardiac transplantation, for patients with heart failure. This study was approved by the institutional review boards of all participating centers.
The study involved two sequential phases. During the baseline period (April 1, 1995, to December
Results
During the baseline period, we collected data on 762 patients with heart failure at intervention hospitals and 640 patients at control hospitals. During the postintervention phase, we collected data on 840 patients at intervention hospitals and 664 patients at control hospitals. Among all patients, 56% were women and 97% were Caucasian. The mean (± SD) age of the patients was 76 ± 11 years; 89% were in NYHA functional class III or IV when admitted. Of the 1,694 patients for whom information
Discussion
The goal of this study was to assess whether an attempt to organize and implement a voluntary, regional, collaborative, multihospital quality improvement program would result in more favorable changes in quality and outcomes than usual care. However, despite establishing conditions that favored implementation and use of a critical pathway, the quality improvement intervention resulted in no increase in the use of pathways and had mixed and statistically nonsignificant effects on five
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Cited by (53)
Modeling of in-hospital treatment outcomes for elderly patients with heart failure: Care pathway versus usual care
2013, European Geriatric MedicineCitation Excerpt :Although some new methods were recently introduced for variable selection in multilevel data analysis [21,22] the most commonly used method for variable selection is to perform univariate analysis first and then apply multilevel analysis which is followed with all the significant factors, found in the previous univariate analysis [23]. There are some other care pathways in the literature to improve hospital treatment outcomes for heart failure patients [24–28]. Although the setting of the some studies was quite different to ours, they all showed effectiveness of care pathways.
Hospitalization epidemic in patients with heart failure: Risk factors, risk prediction, knowledge gaps, and future directions
2011, Journal of Cardiac FailureCitation Excerpt :Because HF readmission risk prediction can have various motives and may differ for patients, providers, payers, or researchers, the need and quality of the prediction model may differ correspondingly. There is intense societal focus on improving medical quality of care.42,196–199 Initial quality measures were process related, and subsequently “hard” outcome measures were introduced, eg, mortality.
Effect of compliance with quality performance measures for heart failure on clinical outcomes in high-risk patients
2010, Journal of the National Medical AssociationPerformance Feedback. A Common Thread in the Process to Provide Optimal Heart Failure Care
2009, Journal of the American College of Cardiology
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Supported in part by VHA Empire State, Inc., and grants from the New York State Department of Health (grant numbers C 011191, C 011696, and C 013333).