RT Journal
A1 Bradley EH, Holmboe ES, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM
T1 A qualitative study of increasing β-blocker use after myocardial infarction: Why do some hospitals succeed?
JF JAMA
JO JAMA
YR 2001
FD May 23
VO 285
IS 20
SP 2604
OP 2611
DO 10.1001/jama.285.20.2604
UL http://dx.doi.org/10.1001/jama.285.20.2604
AB Context 
                  Based on evidence that β-blockers can reduce mortality in patients
with acute myocardial infarction (AMI), many hospitals have initiated performance
improvement efforts to increase prescription of β-blockers at discharge.
Determination of the factors associated with such improvements may provide
guidance to hospitals that have been less successful in increasing β-blocker
use.Objectives 
                  To identify factors that may influence the success of improvement efforts
to increase β-blocker use after AMI and to develop a taxonomy for classifying
such efforts.Design, Setting, and Participants 
                  Qualitative study in which data were gathered from in-depth interviews
conducted in March-June 2000 with 45 key physician, nursing, quality management,
and administrative participants at 8 US hospitals chosen to represent a range
of hospital sizes, geographic regions, and changes in β-blocker use rates
between October 1996 and September 1999.Main Outcome Measures 
                  Initiatives, strategies, and approaches to improve care for patients
with AMI.Results 
                  The interviews revealed 6 broad factors that characterized hospital-based
improvement efforts: goals of the efforts, administrative support, support
among clinicians, design and implementation of improvement initiatives, use
of data, and modifying variables. Hospitals with greater improvements in β-blocker
use over time demonstrated 4 characteristics not found in hospitals with less
or no improvement: shared goals for improvement, substantial administrative
support, strong physician leadership advocating β-blocker use, and use
of credible data feedback.Conclusions 
                  This study provides a context for understanding efforts to improve care
in the hospital setting by describing a taxonomy for classifying and evaluating
such efforts. In addition, the study suggests possible elements of successful
efforts to increase β-blocker use for patients with AMI.