通过“遵循指南”项目对医院绩效的认可与急性心肌梗死和心力衰竭的死亡率

Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure.

作者信息

Heidenreich Paul A, Lewis William R, LaBresh Kenneth A, Schwamm Lee H, Fonarow Gregg C

机构信息

Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA.

出版信息

Am Heart J. 2009 Oct;158(4):546-53. doi: 10.1016/j.ahj.2009.07.031.

DOI:10.1016/j.ahj.2009.07.031

PMID:19781413

Abstract

BACKGROUND

Many hospitals enrolled in the American Heart Association's Get With The Guidelines (GWTG) Program achieve high levels of recommended care for heart failure, acute myocardial infarction (MI) and stroke. However, it is unclear if outcomes are better in those hospitals recognized by the GWTG program for their processes of care.

METHODS

We compared hospitals enrolled in GWTG and receiving achievement awards for high levels of recommended processes of care with other hospitals using data on risk-adjusted 30-day survival for heart failure and acute MI reported by the Center for Medicare and Medicaid Services.

RESULTS

Among the 3,909 hospitals with 30-day data reported by Center for Medicare and Medicaid Services 355 (9%) received GWTG achievement awards. Risk-adjusted mortality for hospitals receiving awards was lower for both heart failure (11.0% vs 11.2%, P = .0005) and acute MI (16.1% vs 16.5%, P < .0001) compared to those not receiving awards. After additional adjustment for hospital characteristics and noncardiac performance measures, the reduction in mortality remained significantly lower for GWTG award hospitals for acute myocardial infraction (-0.19%, 95% CI -0.33 to -0.05), but not for heart failure (-0.11%, 95% CI -0.25 to 0.02). Additional adjustment for cardiac processes of care reduced the benefit of award hospitals by 28% for heart failure mortality and 43% for acute MI mortality.

CONCLUSIONS

Hospitals receiving achievement awards from the GWTG program have modestly lower risk adjusted mortality for acute MI and to a lesser extent, heart failure, explained in part by better process of care.

摘要

背景

许多参与美国心脏协会“遵循指南”（GWTG）项目的医院在心力衰竭、急性心肌梗死（MI）和中风的推荐治疗方面达到了较高水平。然而，尚不清楚在那些因治疗流程而获得GWTG项目认可的医院中，治疗效果是否更好。

方法

我们使用医疗保险和医疗补助服务中心报告的心力衰竭和急性心肌梗死风险调整后30天生存率数据，将参与GWTG并因高水平推荐治疗流程而获得成就奖的医院与其他医院进行了比较。

结果

在医疗保险和医疗补助服务中心报告有30天数据的3909家医院中，355家（9%）获得了GWTG成就奖。与未获奖的医院相比，获奖医院的心力衰竭（11.0%对11.2%，P = 0.0005）和急性心肌梗死（16.1%对16.5%，P < 0.0001）风险调整死亡率均较低。在对医院特征和非心脏性能指标进行额外调整后，GWTG获奖医院急性心肌梗死的死亡率降低幅度仍显著较低（-0.19%，95%可信区间-0.33至-0.05），但心力衰竭的死亡率降低幅度不显著（-0.11%，95%可信区间-0.25至0.02）。对心脏治疗流程进行额外调整后，获奖医院在心力衰竭死亡率方面的获益降低了28%，在急性心肌梗死死亡率方面的获益降低了43%。