1. A Statewide Collaborative Initiative to Improve the Quality of Care for Patients With Acute Myocardial Infarction and Heart Failure Circulation. 2009;119:1609-1615 이설라

2. Introduction QIO : Quality Improvement Organization To enhance quality improvement, we created a unique statewide collaboration among 3 organizations Virginia Health Quality Center (Virginia’s Medicare Quality Improvement Organization) American College of Cardiology American Heart Association The goal was to improve discharge measures for acute myocardial infarction and heart failure

3. In 2004 ~ 2006, 29 hospitals participated in the collaborative initiative analyzed adherence to individual discharge measures and appropriate care measures for acute myocardial infarction, heart failure, and both To control for differences in hospital characteristics, we were able to match 21 of the participating hospitals with 21 similar nonparticipating hospitals

4. AMI : aspirin at discharge β-blocker use at discharge ACEi or ARB use at discharge smoking cessation counseling HF ACEI/ARB use at discharge HF discharge instructions smoking cessation counseling ACM : appropriate care measures RFR : reduction in failure rate

5. Results RFR : reduction in failure rate ACM : appropriate care measure

8. RFR : reduction in failure rate ACM : appropriate care measure

11. mixed results

12. Unique collaboration of a Medicare Quality Improvement Organization and 2 national organizations to address quality of care for acute myocardial infarction and heart failure A composite measure of quality (the total appropriate care measure) improved more in the participating hospitals dependent on participation in a prior collaborative initiative.