Impact of Guidelines on Quality of Care: Unstable Angina

摘要

In May 1994, the Agency for Health Care Policy and Research (AHCPR) releasedClinical Practice Guideline Number 10, Unstable Angina: Diagnosis and Management. In 1997, investigators at the University of Alabama at Birmingham partnered with Alabama's Medicare Peer Review Organization, to study the impact of the release of these guidelines on hospital care for Alabama Medicare beneficiaries with unstable angina. This was a quasi-experimental study of an intervention to improve adherence to unstable angina guidelines that involved the longitudinal analysis of data over a seven-year period beginning just prior to guidelines release and ending in 1999. Methods involved the development of quantitative process-of-care indicators to measure adherence to key aspects of the guidelines. Twenty-two volunteer hospitals were recruited and randomly assigned to a three-armed intervention design: (1) hospital-specific data-feedback of performance on quality indicators combined with a physician opinion leader-driven quality improvement (QI) project intervention; (2) hospital-specific data-driven feedback with a usual model quality improvement project intervention; and (3) no intervention.