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Association between hospital process performance and outcomes among patients with acute coronary syndromes.

Publication ,  Journal Article
Peterson, ED; Roe, MT; Mulgund, J; DeLong, ER; Lytle, BL; Brindis, RG; Smith, SC; Pollack, CV; Newby, LK; Harrington, RA; Gibler, WB; Ohman, EM
Published in: JAMA
April 26, 2006

CONTEXT: Selected care processes are increasingly being used to measure hospital quality; however, data regarding the association between hospital process performance and outcomes are limited. OBJECTIVES: To evaluate contemporary care practices consistent with the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations, to examine how hospital performance varied among centers, to identify characteristics predictive of higher guideline adherence, and to assess whether hospitals' overall composite guideline adherence was associated with observed and risk-adjusted in-hospital mortality rates. DESIGN, SETTING, AND PARTICIPANTS: An observational analysis of hospital care in 350 academic and nonacademic US centers of 64,775 patients enrolled in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) National Quality Improvement Initiative between January 1, 2001, and September 30, 2003, presenting with chest pain and positive electrocardiographic changes or cardiac biomarkers consistent with non-ST-segment elevation acute coronary syndrome (ACS). MAIN OUTCOME MEASURES: Use of 9 ACC/AHA class I guideline-recommended treatments and the correlation among hospitals' use of individual care processes as well as overall composite adherence rates. RESULTS: Overall, the 9 ACC/AHA guideline-recommended treatments were adhered to in 74% of eligible instances. There was modest correlation in hospital performance among the individual ACS process metrics. However, composite adherence performance varied widely (median [interquartile range] composite adherence scores from lowest to highest hospital quartiles, 63% [59%-66%] vs 82% [80%-84%]). Composite guideline adherence rate was significantly associated with in-hospital mortality, with observed mortality rates decreasing from 6.31% for the lowest adherence quartile to 4.15% for the highest adherence quartile (P<.001). After risk adjustment, every 10% increase in composite adherence at a hospital was associated with an analogous 10% decrease in its patients' likelihood of in-hospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.84-0.97; P<.001). CONCLUSION: A significant association between care process and outcomes was found, supporting the use of broad, guideline-based performance metrics as a means of assessing and helping improve hospital quality.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 26, 2006

Volume

295

Issue

16

Start / End Page

1912 / 1920

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Practice Guidelines as Topic
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Guideline Adherence
  • General & Internal Medicine
 

Citation

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Peterson, E. D., Roe, M. T., Mulgund, J., DeLong, E. R., Lytle, B. L., Brindis, R. G., … Ohman, E. M. (2006). Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA, 295(16), 1912–1920. https://doi.org/10.1001/jama.295.16.1912
Peterson, Eric D., Matthew T. Roe, Jyotsna Mulgund, Elizabeth R. DeLong, Barbara L. Lytle, Ralph G. Brindis, Sidney C. Smith, et al. “Association between hospital process performance and outcomes among patients with acute coronary syndromes.JAMA 295, no. 16 (April 26, 2006): 1912–20. https://doi.org/10.1001/jama.295.16.1912.
Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006 Apr 26;295(16):1912–20.
Peterson, Eric D., et al. “Association between hospital process performance and outcomes among patients with acute coronary syndromes.JAMA, vol. 295, no. 16, Apr. 2006, pp. 1912–20. Pubmed, doi:10.1001/jama.295.16.1912.
Peterson ED, Roe MT, Mulgund J, DeLong ER, Lytle BL, Brindis RG, Smith SC, Pollack CV, Newby LK, Harrington RA, Gibler WB, Ohman EM. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006 Apr 26;295(16):1912–1920.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 26, 2006

Volume

295

Issue

16

Start / End Page

1912 / 1920

Location

United States

Related Subject Headings

  • United States
  • Risk Assessment
  • Practice Guidelines as Topic
  • Outcome and Process Assessment, Health Care
  • Middle Aged
  • Male
  • Humans
  • Hospital Mortality
  • Guideline Adherence
  • General & Internal Medicine