TY - JOUR
T1 - Regional differences in quality of care and outcomes for the treatment of acute coronary syndromes
T2 - An analysis from the get with the guidelines coronary artery disease program
AU - Laskey, Warren
AU - Spence, Nathan
AU - Zhao, Xin
AU - Mayo, Rebecca
AU - Taylor, Robert
AU - Cannon, Christopher P.
AU - Hernandez, Adrian F.
AU - Peterson, Eric D.
AU - Fonarow, Gregg C.
PY - 2010/3
Y1 - 2010/3
N2 - Background: Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown. Methods: We evaluated the variation in conformity to the American Heart Association Get With The Guidelines-Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary "all-or-none" process performance measure (primary outcome); an "opportunity-based" overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region. Results: Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the "all-or- none" (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or "opportunity-based" (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest. Conclusion: Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.
AB - Background: Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown. Methods: We evaluated the variation in conformity to the American Heart Association Get With The Guidelines-Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary "all-or-none" process performance measure (primary outcome); an "opportunity-based" overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region. Results: Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the "all-or- none" (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or "opportunity-based" (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest. Conclusion: Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.
KW - Quality of care
KW - Regional variation
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U2 - 10.1097/HPC.0b013e3181cdb5a5
DO - 10.1097/HPC.0b013e3181cdb5a5
M3 - Article
C2 - 20215903
AN - SCOPUS:77949463645
SN - 1535-282X
VL - 9
SP - 1
EP - 7
JO - Critical pathways in cardiology
JF - Critical pathways in cardiology
IS - 1
ER -