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The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association.

Publication ,  Journal Article
Hernandez, AF; Fonarow, GC; Liang, L; Heidenreich, PA; Yancy, C; Peterson, ED
Published in: Circulation
August 9, 2011

BACKGROUND: Process and outcome measures are often used to quantify quality of care in hospitals. Whether these quality measures correlate with one another and the degree to which hospital provider rankings shift on the basis of the performance metric is uncertain. METHODS AND RESULTS: Heart failure patients ≥ 65 years of age hospitalized in the Get With the Guidelines-Heart Failure registry of the American Heart Association were linked to Medicare claims from 2005 to 2006. Hospitals were ranked by (1) composite adherence scores for 5 heart failure process measures, (2) composite adherence scores for emerging quality measures, (3) risk-adjusted 30-day death after admission, and (4) risk-adjusted 30-day readmission after discharge. Hierarchical models using shrinkage estimates were performed to adjust for case mix and hospital volume. There were 19 483 patients hospitalized from 2005 to 2006 from 153 hospitals. The overall median composite adherence rate to heart process measures was 85.8% (25th, 75th percentiles 77.5, 91.4). Median 30-day risk-adjusted mortality was 9.0% (7.9, 10.4). Median risk-adjusted 30-day readmission was 22.9% (22.1, 23.5). The weighted κ for remaining within the top 20th percentile or bottom 20th percentile was ≤ 0.15 and the Spearman correlation overall was ≤ 0.21 between the different measures of quality of care. The average shift in ranks was 33 positions (13, 68) when criteria were changed from 30-day mortality to readmission and 51 positions (22, 76) when ranking metric changed from 30-day mortality to composite process adherence. CONCLUSIONS: Agreement between different methods of ranking hospital-based quality of care and 30-day mortality or readmission rankings was poor. Profiling quality of care will require multidimensional ranking methods and/or additional measures.

Duke Scholars

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 9, 2011

Volume

124

Issue

6

Start / End Page

712 / 719

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Risk
  • Registries
  • Quality Indicators, Health Care
  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Medicare
 

Citation

APA
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ICMJE
MLA
NLM
Hernandez, A. F., Fonarow, G. C., Liang, L., Heidenreich, P. A., Yancy, C., & Peterson, E. D. (2011). The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association. Circulation, 124(6), 712–719. https://doi.org/10.1161/CIRCULATIONAHA.111.026088
Hernandez, Adrian F., Gregg C. Fonarow, Li Liang, Paul A. Heidenreich, Clyde Yancy, and Eric D. Peterson. “The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association.Circulation 124, no. 6 (August 9, 2011): 712–19. https://doi.org/10.1161/CIRCULATIONAHA.111.026088.
Hernandez AF, Fonarow GC, Liang L, Heidenreich PA, Yancy C, Peterson ED. The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association. Circulation. 2011 Aug 9;124(6):712–9.
Hernandez, Adrian F., et al. “The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association.Circulation, vol. 124, no. 6, Aug. 2011, pp. 712–19. Pubmed, doi:10.1161/CIRCULATIONAHA.111.026088.
Hernandez AF, Fonarow GC, Liang L, Heidenreich PA, Yancy C, Peterson ED. The need for multiple measures of hospital quality: results from the Get with the Guidelines-Heart Failure Registry of the American Heart Association. Circulation. 2011 Aug 9;124(6):712–719.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

August 9, 2011

Volume

124

Issue

6

Start / End Page

712 / 719

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Risk
  • Registries
  • Quality Indicators, Health Care
  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Patient Readmission
  • Outcome and Process Assessment, Health Care
  • Medicare