Optimising care of acute myocardial infarction: results of a regional quality improvement project.

The effects of a quality improvement intervention were evaluated in a before-after time-series study of 649 consecutive patients suffering acute myocardial infarction (AMI) in the West Moreton Health District over 2.5 years from March 1996 through to August 1998. After a 6-month baseline period, clinical practice guidelines were issued followed by sequential feedback to providers of clinical indicator data over a 1-year period. Resultant changes in practice were then evaluated during a 12-month post-intervention period. The proportion of eligible patients receiving early thrombolysis, lipid-lowering drugs and cardiac rehabilitation increased, respectively, from 30.8 to 70.0% (P = 0.001), from 23.4 to 56.4% (P = 0.003), and from 23.6 to 54.3% (P = 0.003). The in-hospital death rate, incidence of postinfarct angina and mean length of stay decreased, respectively, from 15.8 to 8.6% (P = 0.02), from 30.1 to 14.3% (P < 0.001), and from 7.4 to 6.3 days (P = 0.001). Despite the absence of control groups, the present study suggested that clinical guidelines combined with feedback of clinical indicators were useful in improving quality of care.

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