Regional differences in quality of care and outcomes for the treatment of acute coronary syndromes: an analysis from the get with the guidelines coronary artery disease program.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Laskey, W; Spence, N; Zhao, X; Mayo, R; Taylor, R; Cannon, CP; Hernandez, AF; Peterson, ED; Fonarow, GC

Published Date

  • March 2010

Published In

Volume / Issue

  • 9 / 1

Start / End Page

  • 1 - 7

PubMed ID

  • 20215903

Pubmed Central ID

  • 20215903

Electronic International Standard Serial Number (EISSN)

  • 1535-2811

International Standard Serial Number (ISSN)

  • 1535-282X

Digital Object Identifier (DOI)

  • 10.1097/hpc.0b013e3181cdb5a5

Language

  • eng