Quality of care for patients with acute coronary syndromes as a function of hospital revascularization capability:
Arun K Thukkani1, Gregg C Fonarow, Christopher P Cannon
1Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Hospitals with revascularization capability showed better adherence to some acute coronary syndrome care measures. However, overall quality improvement is still needed across all hospitals.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Revascularization availability varies among US hospitals, potentially affecting acute coronary syndrome (ACS) patient care quality.
- The Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) registry collects data on ACS patient care.
Purpose of the Study:
- To investigate differences in care quality at GWTG-CAD hospitals based on the availability of revascularization services.
- To compare adherence to performance and quality measures between hospitals with and without revascularization capability.
Main Methods:
- Analysis of 95,999 ACS patients admitted to 310 GWTG-CAD hospitals between 2000 and 2010.
- Comparison of care quality measures between hospitals with (n=226) and without (n=84) revascularization capability.
Main Results:
- Hospitals with revascularization capability demonstrated higher performance for 8 of 19 assessed measures.
- Significantly better adherence was observed for aspirin, clopidogrel, lipid-lowering therapies, blood pressure control, and lifestyle recommendations in the revascularization cohort.
- Odds ratios (OR) and 95% confidence intervals (CI) were reported for key measures, e.g., aspirin (OR: 1.41, CI: 1.04-1.92).
Conclusions:
- GWTG-CAD hospitals with revascularization capability showed improved performance in certain ACS care aspects.
- While differences were modest for performance measures, variability was greater for quality measures, indicating areas for improvement.
- Enhanced adherence to key quality measures is achievable in both hospital types.
Background:
Revascularization availability at US hospitals varies and may impact care quality for acute coronary syndrome patients.
Hypothesis:
The hypothesis of this study was that there would be differences in care quality at Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) hospitals based on revascularization capability.
Methods:
For acute coronary syndrome patients admitted to GWTG-CAD hospitals between 2000 and 2010, care quality at hospitals with or without revascularization capability was examined by assessing conformity with performance and quality measures.
Results:
This study included 95 999 acute coronary syndrome patients admitted to 310 GWTG-CAD hospitals. There were 89 000 patients admitted to 226 revascularization-capable hospitals and 6999 patients admitted to 84 hospitals without revascularization capability included. Adjusted multivariate analysis demonstrated that 8 of the 19 measures were more frequently performed in the revascularization cohort: aspirin (odds ratio [OR]: 1.41, 95% confidence interval [CI]: 1.04-1.92), clopidogrel (OR: 2.31, 95% CI: 1.78-3.00), lipid-lowering therapies at discharge (OR: 1.39, 95% CI: 1.04-1.87), lipid-lowering therapies for low-density lipoprotein >100 mg/dL (OR: 1.85, 95% CI: 1.23-2.77), achievement of blood pressure <140/90 mm Hg (OR: 1.20, 95% CI: 1.03-1.40), LDL recorded (OR: 1.47, 95% CI: 1.05-2.06), and recommendations offered for physical activity (OR: 3.82, 95% CI: 2.23-6.55) or weight management (OR: 1.74, 95% CI: 1.12-2.69).
Conclusions:
The GWTG-CAD revascularization hospitals were associated with better performance in some, but not all, measures assessed. Although the difference in conformity between hospital types was modest for performance measures but more variable for quality measures, room for improvement exists in key aspects of care.
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