Chris J Bond1, Milan Milojevic2, Chang He3, Patricia F Theurer3, Melissa Clark3, Andrew L Pruitt4, Divyakant Gandhi5, Alphonse DeLucia6, Robert N Jones7, Reza Dabir8, Richard L Prager9. 1. Department of Cardiac Surgery, Queen Elizabeth University Hospital, Birmingham, United Kingdom; Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan. Electronic address: chrisbond1@nhs.net. 2. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan. 3. Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan. 4. Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor, Michigan. 5. Department of Cardiac Surgery, McLaren Greater Lansing Hospital, Lansing, Michigan. 6. Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, Michigan. 7. Department of Cardiac Surgery, MidMichigan Medical Center, Alpena, Michigan. 8. Department of Cardiac Surgery, Beaumont Hospital, Dearborn, Michigan. 9. Michigan Society of Thoracic and Cardiovascular Surgery Quality Collaborative, Ann Arbor, Michigan; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: The evidence base favoring utilization of multiple arterial conduits in coronary artery bypass grafting has strengthened in recent years. Nevertheless, utilization of arterial conduits in the US lags behind that of many European peers. We describe a statewide collaborative based approach to improving utilization. METHODS: Four metrics of arterial revascularization were devised. These were displayed and discussed at quarterly statewide quality collaborative meetings from January 2016 onwards, integrated with an educational program regarding attendant benefits. We undertook retrospective review of isolated coronary artery bypass grafting statewide from 2012-2019 to assess impact. RESULTS: A total of 38,523 cases met inclusion/exclusion criteria. Statewide incidence of multiple arterial grafting increased from 7.4% at baseline to 21.7% in 2019 (P < .001), implementation across hospitals varied widely, ranging from 67.6% to 0.0%. Utilization of total arterial revascularization increased 1.9% to 4.4% (P < .001) between time frames. Utilization of both radial artery and bilateral internal thoracic artery conduit increased significantly from 5.3% to 13.2% (P < .001) and 2.1% to 8.5% (P < .001), respectively; radial artery utilization was significantly higher than bilateral internal thoracic artery for each year (P < .001 for all comparisons). CONCLUSIONS: Our statewide quality improvement initiative improved rates of utilization of multiple arterial grafting by all metrics. Barriers to current utilization were identified to guide future quality improvement efforts. This reproducible approach is readily transferable to improve quality of care in other domains and geographical areas.
BACKGROUND: The evidence base favoring utilization of multiple arterial conduits in coronary artery bypass grafting has strengthened in recent years. Nevertheless, utilization of arterial conduits in the US lags behind that of many European peers. We describe a statewide collaborative based approach to improving utilization. METHODS: Four metrics of arterial revascularization were devised. These were displayed and discussed at quarterly statewide quality collaborative meetings from January 2016 onwards, integrated with an educational program regarding attendant benefits. We undertook retrospective review of isolated coronary artery bypass grafting statewide from 2012-2019 to assess impact. RESULTS: A total of 38,523 cases met inclusion/exclusion criteria. Statewide incidence of multiple arterial grafting increased from 7.4% at baseline to 21.7% in 2019 (P < .001), implementation across hospitals varied widely, ranging from 67.6% to 0.0%. Utilization of total arterial revascularization increased 1.9% to 4.4% (P < .001) between time frames. Utilization of both radial artery and bilateral internal thoracic artery conduit increased significantly from 5.3% to 13.2% (P < .001) and 2.1% to 8.5% (P < .001), respectively; radial artery utilization was significantly higher than bilateral internal thoracic artery for each year (P < .001 for all comparisons). CONCLUSIONS: Our statewide quality improvement initiative improved rates of utilization of multiple arterial grafting by all metrics. Barriers to current utilization were identified to guide future quality improvement efforts. This reproducible approach is readily transferable to improve quality of care in other domains and geographical areas.