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]