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.

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.

• Authors: Warren Laskey, Nathan Spence, Xin Zhao, Rebecca Mayo, Robert Taylor, Christopher P Cannon, Adrian F Hernandez, Eric D Peterson, Gregg C Fonarow
• Journal: Critical pathways in cardiology (Crit Pathw Cardiol) Vol. 9 Issue 1 Pg. 1-7 (Mar 2010) ISSN: 1535-2811 [Electronic] United States
• PMID: 20215903 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Acute Coronary Syndrome (mortality, therapy)
• Aged
• Chi-Square Distribution
• Female
• Guideline Adherence
• Hospital Mortality
• Humans
• Internet
• Length of Stay (statistics & numerical data)
• Logistic Models
• Male
• Practice Guidelines as Topic
• Quality of Health Care
• Risk Factors
• Treatment Outcome
• United States (epidemiology)