Intensive care use and quality of care for patients with myocardial infarction and heart failure.

Link to article at PubMed

Intensive care use and quality of care for patients with myocardial infarction and heart failure.

Chest. 2016 Jun 15;

Authors: Valley TS, Sjoding MW, Goldberger ZD, Cooke CR

BACKGROUND: Quality of care for acute myocardial infarction (AMI) and heart failure (HF) varies across hospitals, but factors driving variation are incompletely understood. We evaluated the relationship between a hospital's intensive care unit (ICU) or coronary care unit (CCU) admission rate and quality of care provided to patients with AMI or HF.
METHODS: A retrospective cohort study of Medicare beneficiaries hospitalized in 2010 with AMI or HF was performed. Hospitals were grouped into quintiles by their risk- and reliability-adjusted ICU admission rates for AMI or HF. We examined the rates that hospitals failed to deliver standard AMI or HF processes of care (process measure failure rates), 30-day mortality, 30-day readmissions, and Medicare spending after adjusting for patient and hospital characteristics.
RESULTS: Hospitals in the lowest quintile had ICU admission rates < 29% for AMI or < 8% for HF. Hospitals in the top quintile had rates > 61% for AMI or > 24% for HF. Hospitals in the highest quintile had higher process measure failure rates for some but not all process measures. Hospitals in the top quintile had greater 30-day mortality (14.8% vs. 14.0%, p=0.002 for AMI; 11.4% vs. 10.6%, p<0.001 for HF), but no differences in 30-day readmissions or Medicare spending when compared to hospitals in the lowest quintile.
CONCLUSIONS: Hospitals with the highest rates of ICU admission for patients with AMI or HF delivered lower quality of care and had higher 30-day mortality for these conditions. High ICU use hospitals may be targets to improve care delivery.

PMID: 27318172 [PubMed - as supplied by publisher]

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