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.
Crit Pathw Cardiol
; 9(1): 1-7, 2010 Mar.
Article
em En
| MEDLINE
| ID: mdl-20215903
ABSTRACT
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
/
Fidelidade a Diretrizes
/
Síndrome Coronariana Aguda
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article