Association Between Hospital Process Performance and Outcomes Among Patients With Acute Coronary Syndromes

Peterson, Eric D.; Roe, Matthew T.; Mulgund, Jyotsna; DeLong, Elizabeth R.; Lytle, Barbara L.; Brindis, Ralph G.; Smith, Sidney C.; Pollack, Charles V.; Newby, L. Kristin; Harrington, Robert A.; Gibler, W. Brian; Ohman, E. Magnus

doi:10.1001/jama.295.16.1912

Cited by 608 publications

(438 citation statements)

References 37 publications

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“…There is ongoing debate regarding how to best measure and profile hospital quality using alternative structural, process-of-care, and outcome indicators [4,15,33,42]. The three arthroplasty process measures published by the CMS included prophylactic antibiotic use within 1 hour before surgical incision, appropriate choice of antibiotics, and discontinuation of prophylactic antibiotics within 24 hours after surgery [41].…”

Section: Discussionmentioning

confidence: 99%

Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?

Cai

Cram

Vaughan-Sarrazin

2012

Clinical Orthopaedics &Amp; Related Research

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Background Total joint arthroplasty is widely performed in patients of all races with severe osteoarthritis. Prior studies have reported that African American patients tend to receive total joint arthroplasties in low-volume hospitals compared with Caucasian patients, suggesting potential racial disparity in the quality of arthroplasty care. Questions/purposes We asked whether (1) a hospital outcome measure of risk-adjusted mortality or complication rate within 90 days of primary TKA can be directly used to profile hospital quality of care, and (2) African Americans were more likely to receive TKAs at lowquality hospitals (or hospitals with higher risk-adjusted outcome rate) compared with Caucasian patients. Results The risk-adjusted postoperative mortality/complication rate varied substantially across hospitals; hospitals can be meaningfully categorized into quality groups. In the second cohort of admissions, 8% of African American patients (n = 4894) versus 9.2% of Caucasian patients (n = 86,705) were treated in high-quality hospitals whereas 14.7% of African American patients versus 12.7% of Caucasians patients were treated in low-quality hospitals. After controlling for patient demographic, socioeconomic, geographic, and diagnostic characteristics, the odds ratio for admission to low-quality hospitals was 1.28 for African American patients compared with Caucasian patients (95% CI, 1.18-1.41). Conclusions Among elderly Medicare beneficiaries undergoing TKA, African American patients were more likely than Caucasian patients to be admitted to hospitals with higher risk-adjusted postoperative rates of complications or mortality. Future work is needed to address the residential, social, and referring factors that underlie this disparity and implications for outcomes of care. Patients and Methods

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Section: Discussionmentioning

confidence: 99%

Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?

Cai

Cram

Vaughan-Sarrazin

2012

Clinical Orthopaedics &Amp; Related Research

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“…Every 10% increase in composite adherence to ACC/AHA guideline-recommended therapies was associated with a 10% reduction of in-hospital mortality. 29 …”

Section: Hospital Management and Outcomesmentioning

confidence: 99%

Age and clinical outcomes in patients presenting with acute coronary syndromes

Ahmed

AlHabib

El‐Menyar

et al. 2013

Journal of Cardiovascular Disease Research

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a b s t r a c tContext: Elderly patients have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients. Aims: To examine the impact of age on clinical presentation and outcomes in patients presenting with acute coronary syndrome (ACS). Methods and material: Collected data from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2), which is a prospective multicenter study from six adjacent Arab Middle Eastern Gulf countries. Patients were divided into 3 groups according to their age: 50 years, 51e70 years and >70 years and their clinical characteristics and outcomes were analyzed. Mortality was assessed at one and 12 months. Statistical analysis used: One-way ANOVA test for continuous variables, Pearson chi-square (X 2 ) test for categorical variables and multivariate logistic regression analysis for predictors were performed. Results: Among 7930 consecutive ACS patients; 2755 (35%) were 50 years, 4110 (52%) were 51e70 years and 1065 (13%) >70 years old. The proportion of women increased with increasing age (13% among patients 50 years to 31% among patients > 70 years). The risk factor pattern varied with age; younger patients were more often obese, smokers and had a positive family history of CAD, whereas older patients more likely to have diabetes mellitus, hypertension, and dyslipidemia. Advancing age was associated with under-treatment evidence-based therapies. Multivariate logistic regression analysis after adjusting for relevant covariates showed that old age was independent predictors for re-ischemia (OR 1.29; 95% CI 1.03e1.60), heart failure (OR 2.8; 95% CI 2.17e3.52) and major bleeding (OR 4.02; 95% CI 1.37 e11.77) and in-hospital mortality (age 51e70: OR 2.67; 95% CI 1.86e3.85, and age >70: OR 4.71; 95% CI 3.11e7.14). Conclusion: Despite being higher risk group, elderly are less likely to receive evidence-based therapies and had worse outcomes. Guidelines adherence is highly recommended in elderly.

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“…We used indicators of adherence to guideline-recommended therapy that conform to widely used standards 21,22 , many of which have been shown to be associated with risk of mortality after AMI 23 . Broadly applicable indicators allow comparison of the same indicators of physician guideline adherence in patients with multiple co-morbidities and patients with no co-morbidities.…”

Section: Variables Included In the Analysismentioning

confidence: 99%

Are Co-Morbidities Associated with Guideline Adherence? The MI-Plus Study of Medicare Patients

et al. 2009

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BACKGROUND/OBJECTIVES:The impact of co-morbid illnesses on adherence to guideline recommendations in chronic illness is of growing concern. We tested a framework [Piette and Kerr, Diabetes Care. 29(3):725-31, 2006] of provider adherence to guidelines in the presence of co-morbid conditions, which suggests that the effect of co-morbid conditions depends on treatment recommendations for the co-morbid conditions and how symptomatic they are. METHODS:We conducted an exploratory analysis to assess the framework using chart audit data for 1,240 post-acute myocardial infarction (AMI) Medicare beneficiaries in Alabama. We assessed level of guideline-adherent post-AMI care from chart-based quality indicators and constructed scores reflecting how much care for the comorbid condition was similar to post-AMI care (concordance) and how symptomatic the co-morbid condition is, based on expert opinion. RESULTS:Patients had a mean age of 74 years, mean co-morbidities of 2, and 61% were white. Both concordance and symptomatic scores were positively associated with guideline compliance, with correlations of 0.32 and 0.14, respectively (p <0.001 for each). We found positive correlations between highly concordant co-morbid conditions and post-AMI quality scores and negative correlations between highly symptomatic conditions and post-AMI quality scores; both findings support the framework. However, the framework performed less well for conditions that were not highly concordant or highly symptomatic, and the magnitudes of the associations were not large. CONCLUSIONS:The framework was related to the association of co-morbid conditions with adherence by providers to guideline-recommended treatment for post-AMI patients. The framework holds promise for evaluating and possibly predicting guideline adherence.

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Association Between Hospital Process Performance and Outcomes Among Patients With Acute Coronary Syndromes

Abstract: 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.

Cited by 608 publications

References 37 publications

Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?

Are African American Patients More Likely to Receive a Total Knee Arthroplasty in a Low-quality Hospital?

Age and clinical outcomes in patients presenting with acute coronary syndromes

Are Co-Morbidities Associated with Guideline Adherence? The MI-Plus Study of Medicare Patients

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