Quality Improvement

Report cards showed the strongest benefit when outcome measurement was tied to actionable quality improvement. Patients treated after the QI effort had about fivefold higher odds of receiving multiarterial grafting than patients treated before the effort. Pre-post studies all reported improvements when report cards were combined with active quality improvement interventions. Controlled studies without clear active local quality improvement generally found no significant outcome improvements. The quality improvement effort increased multiarterial grafting broadly but did not eliminate subgroup gaps. The initiative used expert education, transparent hospital performance feedback, and best practice recommendations. ASS team meetings left little room for staff to raise issues because they were mainly structured around team leader announcements. Staff experienced inability to engage meaningfully in quality improvement as a significant loss because they cared about improving care. A team coaching intervention was undermined because staff were not told its actual purpose of overcoming passiveness. The Michigan statewide quality improvement initiative targeted multiarterial grafting in 20…