Managing in-hospital quality improvement: an importance-performance analysis to set priorities for STEMI care

Background: Focus on specific priorities increases the success-rate of quality improvement efforts for broad and complex care processes. Importance-performance analysis presents a possible approach to set priorities around which to design and implement effective quality improvement initiatives. Persistent variation in hospital performance makes STEMI care relevant to consider for importance-performance analysis. Aims: To identify quality improvement priorities in STEMI care. Methods: Importance and performance levels of STEMI key interventions were combined in an importance-performance analysis. Content validity indexes on 23 STEMI key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. Significance of between hospital variation was determined by a Kruskal-Wallis test. A performance heat-map allowed for hospital-specific priority setting. Results: Seven key interventions were rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by PCI and secondary prevention. Between-hospital performance varied significantly over the full spectrum of key interventions (p<0.001). The type and number of priorities varied strongly across hospitals. Conclusions: Guideline adherence in STEMI care is low and improvement priorities vary significantly between hospitals. Importance-performance analysis helps clinicians and management in demarcation of the nature, number and order of improvement priorities. By offering a tailored improvement focus, this methodology makes improvement efforts more specific and achievable.

Jaar van publicatie:2018

BOF-keylabel:ja

IOF-keylabel:ja

BOF-publication weight:1

CSS-citation score:1

Auteurs:International

Authors from:Higher Education

Toegankelijkheid:Open