Managing in-hospital quality improvement: An importance-performance analysis to set priorities for ST-elevation myocardial infarction care.
Eur J Cardiovasc Nurs
; 17(6): 535-542, 2018 08.
Article
em En
| MEDLINE
| ID: mdl-29448818
ABSTRACT
BACKGROUND:
A 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 ST-elevation myocardial infarction care relevant to consider for importance-performance analysis.AIMS:
The purpose of this study was to identify quality improvement priorities in ST-elevation myocardial infarction care.METHODS:
Importance and performance levels of ST-elevation myocardial infarction key interventions were combined in an importance-performance analysis. Content validity indexes on 23 ST-elevation myocardial infarction key interventions of a multidisciplinary RAND Delphi Survey defined importance levels. Structured review of 300 patient records in 15 acute hospitals determined performance levels. The 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 each rated as an overall improvement priority. Priority key interventions related to risk assessment, timely reperfusion by percutaneous coronary intervention and secondary prevention. Between-hospital performance varied significantly for the majority of key interventions. The type and number of priorities varied strongly across hospitals.CONCLUSIONS:
Guideline adherence in ST-elevation myocardial infarction care is low and improvement priorities vary 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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Guias como Assunto
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Atenção à Saúde
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Melhoria de Qualidade
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Intervenção Coronária Percutânea
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Infarto do Miocárdio com Supradesnível do Segmento ST
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Prioridades em Saúde
/
Hospitais
Tipo de estudo:
Etiology_studies
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Guideline
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
Limite:
Adult
/
Aged
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Aged80
/
Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Eur J Cardiovasc Nurs
Assunto da revista:
ANGIOLOGIA
/
CARDIOLOGIA
/
ENFERMAGEM
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Bélgica