Hospital quality for acute myocardial infarction: correlation among process measures and relationship with short-term
Elizabeth H Bradley1, Jeph Herrin, Brian Elbel
1Department of Epidemiology and Public Health, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Conn 06520-8088, USA.
Insights
Publicly reported acute myocardial infarction (AMI) process measures show moderate correlations but explain little variation in hospital mortality rates. Comprehensive quality assessment requires evaluating multiple processes and outcomes, including mortality rates.
Area of Science:
- Cardiology
- Health Services Research
- Quality Improvement
Background:
- Healthcare quality metrics are crucial for patient care evaluation.
- The Centers for Medicare & Medicaid Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) report acute myocardial infarction (AMI) process measures.
- Limited understanding exists regarding the correlation between these AMI process measures and their ability to predict hospital outcomes.
Purpose of the Study:
- To investigate the correlations among core process measures for acute myocardial infarction (AMI).
- To determine the extent to which these AMI process measures explain variations in hospital-specific, risk-standardized, 30-day mortality rates.
Main Methods:
- Analysis of 2002-2003 data from 962 hospitals in the National Registry of Myocardial Infarction (NRMI).
- Assessment of hospital performance on CMS/JCAHO AMI core process measures.
- Correlation of process measures with each other and with hospital-level, risk-standardized, 30-day mortality rates from Medicare claims data.
Main Results:
- Moderate to strong correlations were observed between medication adherence measures (beta-blockers, aspirin, ACE inhibitors).
- Weaker, yet statistically significant, correlations were found between medication measures and smoking cessation counseling or reperfusion times.
- The analyzed process measures collectively explained only 6.0% of the variation in hospital-level, risk-standardized, 30-day mortality rates for AMI patients.
Conclusions:
- Current publicly reported AMI process measures account for a small fraction of the variability in short-term hospital mortality.
- A comprehensive assessment of hospital performance necessitates the inclusion of multiple process measures and outcome indicators, such as risk-standardized mortality rates.
Context:
The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) measure and report quality process measures for acute myocardial infarction (AMI), but little is known about how these measures are correlated with each other and the degree to which inferences about a hospital's outcomes can be made from its performance on publicly reported processes.
Objective:
To determine correlations among AMI core process measures and the degree to which they explain the variation in hospital-specific, risk-standardized, 30-day mortality rates.
Design, Setting, And Participants:
We assessed hospital performance in the CMS/JCAHO AMI core process measures using 2002-2003 data from 962 hospitals participating in the National Registry of Myocardial Infarction (NRMI) and correlated these measures with each other and with hospital-level, risk-standardized, 30-day mortality rates derived from Medicare claims data.
Main Outcome Measures:
Hospital performance on AMI core measures; hospital-specific, risk-standardized, 30-day mortality rates for AMI patients aged 66 years or older.
Results:
We found moderately strong correlations (correlation coefficients > or =0.40; P values <.001) for all pairwise comparisons between beta-blocker use at admission and discharge, aspirin use at admission and discharge, and angiotensin-converting enzyme inhibitor use, and weaker, but statistically significant, correlations between these medication measures and smoking cessation counseling and time to reperfusion therapy measures (correlation coefficients <0.40; P values <.001). Some process measures were significantly correlated with risk-standardized, 30-day mortality rates (P values <.001) but together explained only 6.0% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI.
Conclusions:
The publicly reported AMI process measures capture a small proportion of the variation in hospitals' risk-standardized short-term mortality rates. Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance.
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