Short- and long-term impact of an inpatient quality improvement initiative: results of the CABG-GAP Practice Improvement Project.

Purpose: A significant percentage of patients undergoing coronary artery bypass graft (CABG) surgery leave the hospital without appropriate preventive medications. Little is known about this prevention gap and its solutions. We studied the short- and long-term impacts of a quality improvement (QI) project aimed at reducing this prevention gap.

Methods: A sequential 3-phase QI project was performed in patients undergoing CABG surgery in Olmsted County, MN, from April 2001 to March 2002. In phase 1 (n = 213), cardiovascular surgery team members were given a pocket reminder card with preventive medication guidelines. In phase 2 (n = 182), monthly team feedback reports were added. In phase 3 (n = 199), a "refrigerator magnet" patient reminder card listing prescribed medications was added. A baseline comparison group (n = 305) was selected randomly from patients undergoing CABG surgery in 2000. Patient receipt of preventive medications and all-cause mortality were compared.

Results: Prescription of lipid-lowering medications (LLM) increased with each incremental QI tool as compared with baseline (P < .001). Nonsignificant trends were noted for aspirin, angiotensin-converting enzyme inhibitors, and β-blockers. At 1 year, the use of LLM was similarly high in all groups and was associated with cardiac rehabilitation use. Short- and long-term mortality rates did not differ between study groups.

Conclusions: Our inpatient QI tools resulted in early, high LLM use, but the treatment advantage of the interventions was erased by 1 year and no survival benefit was noted. Our study illustrates the importance of tracking long-term outcomes in QI projects and suggests that outpatient cardiac rehabilitation is associated with long-term use of LLM.