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Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery

2018; Lippincott Williams & Wilkins; Volume: 11; Issue: 11 Linguagem: Inglês

10.1161/circoutcomes.118.004756

1941-7705

Donald S. Likosky, Steven D. Harrington, Lourdes Cabrera, Alphonse DeLucia, Carol Chenoweth, Sarah L. Krein, Dylan Thibault, Min Zhang, Roland Matsouaka, Raymond J. Strobel, Richard L. Prager,

Clinical practice guidelines implementation

Background: To date, studies evaluating outcome improvements associated with participation in physician-led collaboratives have been limited by the absence of a contemporaneous control group. We examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. Methods and Results: We evaluated 911 754 coronary artery bypass operations (July 1, 2011, to June 30, 2017) performed across 1198 hospitals participating in a voluntary national physician reporting program (Society of Thoracic Surgeons [STS]), including 33 that participated in a Michigan-based collaborative (MI-Collaborative). Unlike STS hospitals not participating in the MI-Collaborative (i.e., STSnonMI) that solely received blinded reports, MI-Collaborative hospitals received a multi-faceted intervention starting November 2012 (quarterly in-person meetings showcasing unblinded data, webinars, site visits). Eighteen of the MI-Collaborative hospitals received additional support to implement recommended pneumonia prevention practices (“MI-CollaborativePlus”), whereas 15 did not (“MI-CollaborativeOnly”). We evaluated rates of postoperative pneumonia, adjusting for patient mix and hospital effects. Baseline patient characteristics were qualitatively similar between groups and time. During the pre-intervention period (Q3/2011 through Q3/2012), there was no statistically significant difference in the adjusted odds of pneumonia for STS hospitals participating in the MI-Collaborative compared to the STS non-MI hospitals. However, during the intervention period (Q4/2012 through Q2/2017), there was a significant 2% reduction per quarter in the adjusted odds of pneumonia for MI-Collaborative hospitals ( n =33) relative to the STS non-MI hospitals. There was a significant 3% per quarter reduction in the adjusted odds of pneumonia for the MI-Collaborative Only ( n =15) hospitals relative to the STS non-MI hospitals. Over the course of the overall study period, the STS non-MI hospitals had a 1.96% reduction in risk-adjusted pneumonia (pre- vs. intervention periods), which was less than the MI-Collaborative (3.23%, P =0.011). Over the same time period, the MI-Collaborative Plus ( n =18) reduced adjusted pneumonia rates by 10.29%, P =0.001. Conclusions: Participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. Interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02068716.