Assessing performance reports to individual providers in the care of acute coronary syndromes

BACKGROUND: As part of a quality improvement initiative in the management of acute coronary syndromes, performance reports on care of patients with acute myocardial infarction (MI) or unstable angina (UA) who were admitted to two cardiology services at the University of Michigan Medical Center in 1999 were disseminated to a range of providers. METHODS: In 1999, data were routinely collected by chart review on presentation, comorbidities, treatments, outcomes, and key process of care indicators for nearly 300 patients with AMI and a similar number of patients with acute UA. Key process of care indicators and outcomes were the focus of the report cards for AMI and UA. RESULTS OF SURVEY ON REPORT CARDS: The return rate for the provider survey--a simple one-page, nine-item question/answer sheet--was highest among faculty who received physician-specific reports (14 out of 17; 82%). Overall, 18 (60%) of 30 providers indicated that the report was useful, 18 responded favorably to the format, and only 3 (10%) indicated that the information was repetitive. Importantly, 24 (80%) indicated a desire to see future performance reports. DISCUSSION: Although hospitalwide or even statewide reports have become familiar, their overall impact on care within hospitals or health systems is unknown. Because so many different caregivers affect the care of a single patient, it is difficult to identify all of these and to consider which part of the care oversight should be ascribed to each provider. The care process itself must be reengineered to build in the systems and time required to accomplish continuous evaluation and improvement.