Dharmarajan Kumar, McNamara Robert L, Wang Yongfei, Masoudi Frederick A, Ross Joseph S, Spatz Erica E, Desai Nihar R, de Lemos James A, Fonarow Gregg C, Heidenreich Paul A, Bhatt Deepak L, Bernheim Susannah M, Slattery Lara E, Khan Yosef M, Curtis Jeptha P
From Clover Health, Jersey City, New Jersey; Center for Outcomes Research & Evaluation, Yale New Haven Health, and Yale School of Medicine, New Haven, Connecticut; University of Colorado Anschutz Medical Campus, Denver, Colorado; University of Texas Southwestern Medical Center and American Heart Association, Dallas, Texas; Ronald Reagan UCLA Medical Center, Los Angeles, California; Stanford University Medical Center, Palo Alto, California; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and American College of Cardiology, Washington, DC.
Ann Intern Med. 2017 Oct 17;167(8):555-564. doi: 10.7326/M16-2871. Epub 2017 Sep 26.
Publicly reported hospital risk-standardized mortality rates (RSMRs) for acute myocardial infarction (AMI) are calculated for Medicare beneficiaries. Outcomes for older patients with AMI may not reflect general outcomes.
To examine the relationship between hospital 30-day RSMRs for older patients (aged ≥65 years) and those for younger patients (aged 18 to 64 years) and all patients (aged ≥18 years) with AMI.
Retrospective cohort study.
986 hospitals in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry-Get With the Guidelines.
Adults hospitalized for AMI from 1 October 2010 to 30 September 2014.
Hospital 30-day RSMRs were calculated for older, younger, and all patients using an electronic health record measure of AMI mortality endorsed by the National Quality Forum. Hospitals were ranked by their 30-day RSMRs for these 3 age groups, and agreement in rankings was plotted. The correlation in hospital AMI achievement scores for each age group was also calculated using the Hospital Value-Based Purchasing (HVBP) Program method computed with the electronic health record measure.
267 763 and 276 031 AMI hospitalizations among older and younger patients, respectively, were identified. Median hospital 30-day RSMRs were 9.4%, 3.0%, and 6.2% for older, younger, and all patients, respectively. Most top- and bottom-performing hospitals for older patients were neither top nor bottom performers for younger patients. In contrast, most top and bottom performers for older patients were also top and bottom performers for all patients. Similarly, HVBP achievement scores for older patients correlated weakly with those for younger patients (R = 0.30) and strongly with those for all patients (R = 0.92).
Minority of U.S. hospitals.
Hospital mortality rankings for older patients with AMI inconsistently reflect rankings for younger patients. Incorporation of younger patients into assessment of hospital outcomes would permit further examination of the presence and effect of age-related quality differences.
American College of Cardiology.
急性心肌梗死（AMI）的医院风险标准化死亡率（RSMR）是针对医疗保险受益人计算得出的。老年AMI患者的结局可能无法反映总体结局。
研究老年患者（年龄≥65岁）、年轻患者（年龄18至64岁）以及所有AMI患者（年龄≥18岁）的医院30天RSMR之间的关系。
回顾性队列研究。
急性冠状动脉治疗与干预结局网络（ACTION）注册登记处——遵循指南的986家医院。
2010年10月1日至2014年9月30日因AMI住院的成年人。
使用国家质量论坛认可的电子健康记录AMI死亡率指标，计算老年、年轻和所有患者的医院30天RSMR。根据这三个年龄组的30天RSMR对医院进行排名，并绘制排名一致性图表。还使用基于医院价值购买（HVBP）计划方法和电子健康记录指标计算每个年龄组医院AMI绩效得分的相关性。
分别确定了老年和年轻患者中267763例和276031例AMI住院病例。老年、年轻和所有患者的医院30天RSMR中位数分别为9.4%、3.0%和6.2%。大多数老年患者中表现最佳和最差的医院在年轻患者中既非最佳也非最差。相比之下，老年患者中大多数表现最佳和最差的医院在所有患者中也是表现最佳和最差的。同样，老年患者的HVBP绩效得分与年轻患者的得分相关性较弱（R = 0.30），与所有患者的得分相关性较强（R = 0.92）。
美国医院数量有限。
老年AMI患者的医院死亡率排名并不能一致地反映年轻患者的排名。将年轻患者纳入医院结局评估将有助于进一步研究与年龄相关的质量差异的存在及其影响。
美国心脏病学会。
