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The Cooperative Cardiovascular Project in Oklahoma
D W Bratzler1, A C de Leon, M C Johnson
1Oklahoma Foundation for Medical Quality, Inc., Oklahoma City 73118-9984, USA.
Insights
Potentially life-saving treatments for acute myocardial infarction are underused in Medicare patients. Quality improvement efforts are needed to ensure optimal care for beneficiaries hospitalized with heart attacks.
Area of Science:
- Cardiology
- Health Services Research
- Quality Improvement
Background:
- Acute myocardial infarction (AMI) is a leading cause of death in the US.
- AMI is a common reason for hospitalization among Oklahoma Medicare beneficiaries.
- The Cooperative Cardiovascular Project aimed to assess AMI care quality for Medicare patients.
Purpose of the Study:
- To evaluate the quality of care for Medicare beneficiaries hospitalized with acute myocardial infarction.
- To identify performance measures for AMI management based on established guidelines.
- To support hospital-based quality improvement initiatives for AMI care.
Main Methods:
- Retrospective review of inpatient medical records.
- Analysis of 3,436 patients from 102 Oklahoma hospitals.
- Inclusion of a national random sample of 2,441 AMI patients.
Main Results:
- Diagnosis of AMI confirmed in 89% of reviewed cases.
- Reperfusion therapy used in 62% of ideal candidates; aspirin in 84% during hospitalization and 76% at discharge.
- Beta-blocker use at discharge was 40%; significant inter-hospital variations noted for key treatments and counseling.
Conclusions:
- Underutilization of potentially life-saving treatments for hospitalized Medicare patients with AMI.
- Improving the quality of care for Medicare beneficiaries with AMI is a national health priority.
Background And Objectives:
Acute myocardial infarction is the leading cause of death in the United States and a common cause for admission of Oklahoma Medicare beneficiaries. Based on guidelines for the management of acute myocardial infarction published by a joint committee of the American College of Cardiology and the American Heart Association, the Cooperative Cardiovascular Project was developed by the Health Care Financing Administration to measure performance on quality indicators that describe care provided to Medicare beneficiaries. The objective of the project is to use those performance measures to assist hospitals in the development of quality improvement efforts for acute myocardial infarction care.
Methods:
Retrospective review was performed on the inpatient medical records of 3,436 patients from 102 hospitals in Oklahoma and a random national sample of 2,441 patients discharged with a principal diagnosis of acute myocardial infarction.
Results:
The diagnosis of acute myocardial infarction was confirmed in 3,055 (89%) of the cases reviewed. For patients considered to be ideal candidates for an intervention, 62% received reperfusion therapy (thrombolytic or PTCA), 84% received aspirin during the hospitalization, 76% received aspirin at discharge, and 40% received beta-blockers at discharge. There were significant variations in performance between hospital peer groups in the use of reperfusion therapy, aspirin, beta-blockers, and smoking cessation counseling.
Conclusions:
Potentially life-saving treatments for Medicare patients hospitalized with an acute myocardial infarction are often underutilized. Improving quality of care for Medicare beneficiaries with acute myocardial infarction has been identified as a national priority.