Targeted versus standard feedback: Results froma RandomizedQuality Improvement Trial

Barbara L. Lytle, Shuang Li, David M. Lofthus, Laine Thomas, Jennifer L. Poteat, Deepak L. Bhatt, Christopher P. Cannon, Gregg C. Fonarow, Eric D. Peterson, Tracy Y. Wang, Karen P. Alexander

Research output: Contribution to journalArticlepeer-review

Abstract

Background Quality improvement is central to improving the care of patients with cardiovascular disease; however, the optimum type of data feedback to support such efforts is unknown. Methods Over 26 months, 149 eligible Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines hospitals were randomized to receive either standard (n = 76 control) or targeted (n = 73 intervention) performance feedback reports for acute myocardial infarction patient care. Each report summarized performance on identified metrics (providing hospitals with detailed data on their 3 lowest-performing quality metrics, relative to their peers). Intervention sites received 5 targeted feedback reports. Overall composite performance was compared between cohorts at end of study and as a change from baseline. Results Intervention (n = 60) and control (n = 64) hospitals that completed the study had similar baseline performance (median score 83.7% vs 84.2%). Over 26 months of follow-up, the change in overall composite score across hospitals was neutral (median 0.1% [interquartile range {IQR} -2.4% to 3.3%]). There was no difference in observed improvement in either the intervention (median -0.2% [IQR-2.6% to 3.3%]) or control (median 0.1% [IQR -2.2% to 3.4%]) hospitals. Conclusions We were unable to demonstrate that targeted performance feedback reports lead to more rapid care improvements than standard reports. Future directions should explore the relationship between hospital self-selection of targeted metrics and the identification and promulgation of less common metrics-particularly those that reflect processes of care.

Original languageEnglish (US)
Pages (from-to)132-141.e2
JournalAmerican heart journal
Volume169
Issue number1
DOIs
StatePublished - Jan 2015
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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