Administrative Data Feedback for Effective Cardiac Treatment: AFFECT, a cluster randomized trial

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.