Related Experiment Video
Updated: Mar 17, 2026
Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
Published on: November 3, 2023
Association Between Hospital Process Composite Performance and Patient Outcomes After In-Hospital Cardiac Arrest Care
Monique L Anderson1, Graham Nichol2, David Dai1
1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
Insights
Hospital quality of care for in-hospital cardiac arrest (IHCA) significantly impacts patient survival. Higher adherence to IHCA care guidelines is linked to better survival and neurologic outcomes.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Clinical Outcomes Research
Background:
- Survival rates following in-hospital cardiac arrest (IHCA) show considerable variation across US hospitals.
- The extent to which differences in IHCA care quality contribute to this variation remains unclear.
Purpose of the Study:
- To assess hospital-level variations in IHCA care.
- To determine if composite performance measures of IHCA care quality are associated with patient outcomes.
Main Methods:
- Analysis of 35,283 adult IHCA patients from the Get With the Guidelines-Resuscitation (GWTG-R) program (2010-2012).
- Calculation of hospital process composite performance scores based on 5 guideline-recommended measures.
- Association of performance scores with risk-standardized survival and neurologic status using hierarchical logistic regression.
Main Results:
- A linear association was observed between IHCA process composite performance and survival to discharge rates.
- Each 10% increase in performance score correlated with a 22% higher odds of survival (aOR, 1.22; 95% CI, 1.08-1.37).
- Higher hospital process composite quality performance was also significantly associated with favorable neurologic status at discharge.
Conclusions:
- Guideline-based care quality for IHCA varies substantially among US hospitals.
- Hospital quality of IHCA care is demonstrably linked to patient survival and neurologic outcomes.
Importance:
Survival rates after in-hospital cardiac arrest (IHCA) vary significantly among US centers; whether this variation is owing to differences in IHCA care quality is unknown.
Objective:
To evaluate hospital-level variation to determine whether hospital process composite performance measures of IHCA care quality are associated with patient outcomes.
Design, Setting, And Participants:
Using data from the American Heart Association's Get With the Guidelines-Resuscitation (GWTG-R) program, we analyzed 35 283 patients 18 years or older with IHCA treated at 261 US hospitals from January 1, 2010, through December 31, 2012. We calculated the hospital process composite performance score for IHCA using 5 guideline-recommended process measures. Opportunity-based scores were calculated for all patients, aggregated at the hospital level, divided into quartiles, and then associated with risk-standardized survival and neurologic status by a test for trend. The scores were then evaluated through hierarchical logistic regression and reported as odds ratios per 10% increment in hospital process composite performance.
Interventions:
Acute care treatments for IHCA.
Main Outcomes And Measures:
The primary outcome was survival to discharge measured as risk standard survival rates, and the secondary outcome was favorable neurologic status at hospital discharge.
Results:
Of the 35 283 adults included in this study, the median age was 67 years (interquartile range [IQR] 56-78 years), and 57.9% were male. The median IHCA hospital process composite performance was 89.7% (interquartile range, 85.4%-93.1%) and varied among hospital quartiles from 82.6% (lowest) to 94.8% (highest). The IHCA hospital process composite performance was linearly associated with risk-standardized hospital survival to discharge rates: 21.1%, 21.4%, 22.8%, and 23.4% from lowest to highest performance quartiles, respectively (P < .001). After adjustment, each 10% increase in a hospital's process composite performance was associated with a 22% higher odds of survival (adjusted odds ratio, 1.22; 95% CI, 1.08-1.37; P = .01). Hospital process composite quality performance was also associated with favorable neurologic status at discharge (P = .004).
Conclusions And Relevance:
The quality of guideline-based care for IHCA varies significantly among US hospitals and is associated with patient survival and neurologic outcomes.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Cardiopulmonary Resuscitation I: Adult
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management