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Journal Article


Quality of Care for Coronary Heart Disease in Two Countries

The Issue

Coronary heart disease accounts for a substantial fraction of deaths in the United States and England, and the delivery of cardiac care is costly. The authors of this Commonwealth Fund–supported study identify lessons each country can learn from the other for reducing cardiac disease burdens, despite health system differences.

What the Study Found

Certain strategies used successfully in at least one of the two countries deserve serious consideration by the other:

  • Clinical guidelines. In the U.S., professional organizations' guidelines, which sometimes become de facto standards, have been especially influential.
  • National standards. Under its centralized health system, England has adopted a wide range of national cardiac care standards.
  • Public release of performance reports. In the U.S., performance reports have spurred hospitals to undertake quality improvement efforts and may have contributed to better clinical outcomes. Still, they have had "only a limited impact" on the decisions of patients, physicians, and insurers in choosing hospitals for cardiac surgery.
  • Benchmarking, feedback, and professional leadership. Together, these represent "one of the most promising avenues for shared learning between the United States and England" and have stimulated improvements by local providers.
  • Market-oriented approaches. Financial incentives have increased the efficiency of cardiac care in England but "have been used surprisingly little in the market-based U.S. system."


An approach employing multiple strategies, rather than a single one, will likely lead to greater improvements in cardiac care, the authors conclude. In both countries, changes in information systems, organizational culture, and incentives are the keys to achieving sustainable improvements.

Publication Details



J. Z. Ayanian and T. J. Quinn, "Quality of Care for Coronary Heart Disease in Two Countries," Health Affairs, May/June 2001 20(3):55–67.