Collaborative Quality Improvement Reduces Postoperative Pneumonia After Isolated Coronary Artery Bypass Grafting Surgery
Likosky DS, Harrington SD, Cabrera L, DeLucia A, 3rd, Chenoweth CE, Krein SL, Thibault D, Zhang M, Matsouaka RA, Strobel RJ, and Prager RL. Collaborative quality improvement reduces postoperative pneumonia after isolated coronary artery bypass grafting surgery. Circ Cardiovasc Qual Outcomes 2018; 11(11):e004756.
Circ Cardiovasc Qual Outcomes
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, there was a 2.53% per quarter reduction in the adjusted neumonia odds ratio for STS hospitals not participating in the MI-Collaborative ( P0.05). During the intervention period, there was a significant 2% reduction in the adjusted odds ratio for pneumonia for MI-Collaborative hospitals relative to the STS hospitals not participating in the MI-Collaborative, although was 3% significantly lower among the MI-CollaborativeOnly hospitals. The STS hospitals not participating in the MI-Collaborative had a 1.96% reduction in risk-adjusted pneumonia, which was less than the MI-Collaborative (3.23%, P=0.011). The MI-CollaborativePlus 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.
Medical Subject Headings
Adult; Aged; Coronary Artery Bypass; Female; Humans; Interdisciplinary Placement; Male; Middle Aged; Physicians; Pneumonia; Postoperative Complications; Prevalence; Quality Improvement; Treatment Outcome; United States