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Cited by 479Clinical practice guidelines implementationHealth Policy Implementation ScienceAcute Myocardial Infarction Research

The DOI matches its Crossref record; 44 of the 44 references it cites were found in a registry or an index.

Effect of Local Medical Opinion Leaders on Quality of Care for Acute Myocardial Infarction: A Randomized Controlled Trial

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Soumerai, Stephen B., McLaughlin, Thomas J., Gurwitz, Jerry H., Guadagnoli, Edward, Hauptman, Paul J., Borbas, Catherine, Morris, Nora, McLaughlin, Barbara, Gao, Xiaoming, Willison, Donald J., Asinger, Richard, Gobel, Fredarick·1998·JAMA
DOI 10.1001/jama.279.17.1358
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Abstract

CONTEXT: The effectiveness of recruiting local medical opinion leaders to improve quality of care is poorly understood. OBJECTIVE: To evaluate a guideline-implementation intervention of clinician education by local opinion leaders and performance feedback to (1) increase use of lifesaving drugs (aspirin and thrombolytics in eligible elderly patients, beta-blockers in all eligible patients) for acute myocardial infarction (AMI), and (2) decrease use of a potentially harmful therapy (prophylactic lidocaine). DESIGN: Randomized controlled trial with hospital as the unit of randomization, intervention, and analysis. SETTING: Thirty-seven community hospitals in Minnesota. PATIENTS: All patients with AMI admitted to study hospitals over 10 months before (1992-1993, N=2409) or after (1995-1996, N=2938) the intervention. INTERVENTION: Using a validated survey, we identified opinion leaders at 20 experimental hospitals who influenced peers through small and large group discussions, informal consultations, and revisions of protocols and clinical pathways. They focused on (1) evidence (drug efficacy), (2) comparative performance, and (3) barriers to change. Control hospitals received mailed performance feedback. MAIN OUTCOME MEASURES: Hospital-specific changes before and after the intervention in the proportion of eligible patients receiving each study drug. RESULTS: Among experimental hospitals, the median change in the proportion of eligible elderly patients receiving aspirin was +0.13 (17% increase from 0.77 at baseline), compared with a change of -0.03 at control hospitals (P=.04). For beta-blockers, the respective changes were +0.31 (63% increase from 0.49 at baseline) vs +0.18 (30% increase from baseline) for controls (P=.02). Lidocaine use declined by about 50% in both groups. The intervention did not increase thrombolysis in the elderly (from 0.73 at baseline), but nearly two thirds of eligible nonrecipients were older than 85 years, had severe comorbidities, or presented after at least 6 hours. CONCLUSIONS: Working with opinion leaders and providing performance feedback can accelerate adoption of some beneficial AMI therapies (eg, aspirin, beta-blockers). Secular changes in knowledge and hospital protocols may extinguish outdated practices (eg, prophylactic lidocaine). However, it is more difficult to increase use of effective but riskier treatments (eg, thrombolysis) for frail elderly patients.

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Authors
Soumerai, S. B., McLaughlin, T. J., Gurwitz, J. H., Guadagnoli, E., Hauptman, P. J., Borbas, C., Morris, N., McLaughlin, B., Gao, X., Willison, D. J., Asinger, R., & Gobel, F.
Affiliations
  • Harvard University (US)
  • University of Massachusetts Chan Medical School (US)
  • McMaster University (CA)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
1998-05-06
Volume
279
Issue
17
Pages
1358
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.279.17.1358
OpenAlex
W2052012471
Cited by
479
References
43
Citations by year
2026: 2 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 7 · 2020: 6 · 2019: 11 · 2018: 5 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 14 · 2013: 10 · 2012: 10
FWCI
33.47
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
Agency for Healthcare Research and Quality (HSO7357)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
acute myocardial infarction, guideline implementation, clinician education, performance feedback, aspirin, beta-blockers, thrombolysis, quality of care, community hospitals, elderly patients, care pathways, peer influence, barriers to change, medication use, secondary prevention, evidence-based practice adoption, 1990s
MeSH terms
Adrenergic beta-Antagonists, Anti-Arrhythmia Agents, Aspirin, Cardiology, Drug Utilization, Fibrinolytic Agents, Hospitals, Community, Humans, Interprofessional Relations, Lidocaine, Minnesota, Myocardial Infarction, Platelet Aggregation Inhibitors, Quality of Health Care, Thrombolytic Therapy, Cardiology Service, Hospital, Practice Guidelines as Topic, Statistics, Nonparametric, Critical Pathways, Guideline Adherence

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