Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (A.H.Q., M.V.-S., S.G.).
Saint Luke's Mid America Heart Institute and the University of Missouri, Kansas City (P.S.C.).
Circ Cardiovasc Qual Outcomes. 2020 Sep;13(9):e006514. doi: 10.1161/CIRCOUTCOMES.120.006514. Epub 2020 Sep 10.
A hospital's risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time.
We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012-2013) and two follow-up periods (2014-2015 and 2016-2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals' at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at ≈45% of study hospitals, ≈1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline.
Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.
医院院内心脏骤停的风险标准化生存率（RSSR）已成为基准和激励医院复苏质量的重要指标。我们研究了医院在 RSSR 指标上的表现是否逐年稳定或动态，以及表现不佳的医院是否能够随着时间的推移提高生存率。
我们使用了 2012 年至 2017 年期间来自 166 家医院的 84089 名成年院内心脏骤停患者的数据，这些医院连续参与了 Get With The Guidelines-Resuscitation。使用 2 级分层回归模型在基线（2012-2013 年）和两个随访期（2014-2015 年和 2016-2017 年）期间计算 RSSRs。在基线时，如果医院在 2012 年至 2013 年期间的 RSSR 指标中分别排名在前 25%、中间 50%和最后 25%，则将其归类为表现最佳、表现中等和表现最差的医院。我们比较了基线时表现最佳、表现中等和表现最差的医院在随访期间 RSSR 的医院表现。在 2012 年至 2013 年期间，确定了 42 家表现最佳的医院（中位数 RSSR，31.7%）、82 家中等表现的医院（中位数 RSSR，24.6%）和 42 家表现最差的医院（中位数 RSSR，18.7%）。在两个随访期内，>70%的表现最佳的医院在排名前 50%，相当一部分医院在 2014-2015 年（54.6%）和 2016-2017 年（40.4%）的随访期间仍在前 25%的 RSSR 中。同样，在两个随访期内，近 75%的表现最差的医院仍在排名后 50%，其中 50.0%在 2014-2015 年的 RSSR 中排名后 25%，40.5%在 2016-2017 年的 RSSR 中排名后 25%。虽然在大约 45%的研究医院中，等级排名在整个研究期间通常保持一致，但大约 1/5（21.4%）的表现最差的医院的等级排名随着时间的推移有了显著提高，而表现最佳的医院中有类似比例（23.7%）的医院的等级排名与基线相比有了显著下降。
在 4 年的随访期间，医院在基线期的 RSSR 表现通常保持一致。然而，1/5 的表现最差的医院的生存率随着时间的推移有了显著提高。确定这些医院的护理和质量改进创新可能为其他医院改善院内心脏骤停护理提供机会。
