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Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial
Christine A Beck1, Hugues Richard, Jack V Tu
1Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Hospital report cards using administrative data did not improve care for acute myocardial infarction (AMI) patients. Further research is needed to evaluate more intensive interventions for quality improvement.
Area of Science:
- Health Services Research
- Cardiovascular Medicine
- Health Informatics
Background:
- Hospital report cards are increasingly used for quality improvement.
- Evidence supporting their effectiveness is limited.
- This study evaluates report cards using linked administrative data.
Purpose of the Study:
- To assess the effectiveness of hospital report cards in improving the quality of care for acute myocardial infarction (AMI).
- To determine if linked hospital and prescription administrative databases can create effective report cards.
Main Methods:
- A cluster randomized trial (Administrative Data Feedback for Effective Cardiac Treatment - AFFECT study) involving 76 hospitals in Quebec.
- Hospitals received rapid or delayed feedback on quality indicators derived from administrative data.
- Primary outcome was 30-day post-discharge beta-blocker prescription rates for elderly AMI survivors.
Main Results:
- No significant differences were observed between rapid and delayed feedback groups in beta-blocker, ACE inhibitor, lipid-lowering drug, or aspirin prescription rates.
- Adjusted mortality, hospital stay length, physician visits, procedure waiting times, and readmission rates were similar between groups.
- The study found no improvement in quality indicators or patient outcomes.
Conclusions:
- One-time, confidential hospital report cards based on administrative data are ineffective for improving AMI care quality.
- More intensive report card interventions require rigorous evaluation.
- Future research should explore alternative or enhanced feedback strategies.
Context:
Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use.
Objective:
To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction (AMI).
Design:
The Administrative Data Feedback for Effective Cardiac Treatment (AFFECT) study, a cluster randomized trial.
Setting And Patients:
Patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1, 1999, and March 31, 2003.
Intervention:
Hospitals were randomly assigned to receive rapid (immediate; n = 38 hospitals and 2533 patients) or delayed (14 months; n = 38 hospitals and 3142 patients) confidential feedback on quality indicators constructed using administrative data.
Main Outcome Measures:
Quality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization. The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge.
Results:
At follow-up, adjusted prescription rates within 30 days after discharge were similar in the early vs late groups (for beta-blockers, odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82-1.37; for angiotensin-converting enzyme inhibitors, OR, 1.17; 95% CI, 0.90-1.52; for lipid-lowering drugs, OR, 1.14; 95% CI, 0.86-1.50; and for aspirin, OR, 1.05; 95% CI, 0.84-1.33). In addition, adjusted mortality was similar in both groups, as were length of in-hospital stay, physician visits after discharge, waiting times for invasive cardiac procedures, and readmissions for cardiac complications.
Conclusions:
Feedback based on one-time, confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI. A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions.
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