Abstract
During the past decade there has been increasing distribution of hospital performance information but few examples of how this information is affecting the quality of health care delivery. This article describes the methods of implementation and factors influencing a successful community-based quality improvement initiative in Dayton, Ohio, involving a collaborative of five competing hospitals in partnership with the business community and local and state hospital associations. The initiative contributed to a 36% reduction in acute myocardial infarction mortality over a 3-year period by changing reperfusion patterns in patients with ST segment elevated myocardial infarction. Identification of an opportunity gap, root cause analysis, and development of process measures used to facilitate health care provider change are summarized. The driving and restraining forces that have shaped this initiative from a report card to a quality improvement program are outlined and a list of five contributors to success are presented. These factors can serve as a basis for how other communities can benefit from this collaborative model.
Community-based health care quality measurement programs have shown mixed results in demonstrating improvement within the communities they serve. Programs such as The Northern New England Cardiovascular Collaborative have demonstrated reductions in mortality and complications when a multi-institutional process and outcome comparison is used in the framework of continuous quality improvement.1 Other programs such as the Cleveland Quality Choice Program or the Pennsylvania Health Care Cost Containment Council either generate conflicting results or minimal public interest.2-5 This article presents a model of health care quality improvement driven by health care providers in a competitive environment that has achieved success in improving patient care. In addition, this article provides a summary of the key elements for the success of the program that could be found in any community.