Author Affiliations: Newton, Massachusetts.
In this issue of JAMA, Berwanger and colleagues1 report a teaching-case–perfect cluster-randomized trial demonstrating the positive effects of a “multifaceted intervention” to improve the reliability of evidence-based management of acute coronary systems in general hospitals in Brazil. With a combination of reminders, a checklist, case management, and staff education, the intervention hospitals used all eligible acute therapies in the first 24 hours after admission 37% more often than control hospitals (67.9% vs 49.5%) and used all evidence-based therapies (ie, not just acute management) 67% more reliably (50.9% vs 31.9%).
Donald M. Berwick. The Question of Improvement. JAMA. 2012;307(19):2093–2094. doi:10.1001/jama.2012.4146