Key result
Only 8% of the total variation in hospital adherence to a composite of key performance measures for heart failure management was attributable to hospital-level features.
Why the study?
What is the extent of hospital-level variation in adherence to key performance measures for heart failure management?
Observational (n=68,772)
Yes
What is the extent of hospital-level variation in adherence to key performance measures for heart failure management?
Effect estimate: ICC 8% (95% CI 7%-10%)
Only a small proportion of hospital variation in medication prescription after discharge for HFrEF was attributable to hospital-level features, suggesting differences in hospital practices are not a major determinant of prescription variations.
Hospital features explain little HF performance variation; leaves open patient-level and unmeasured factors as primary targets for adherence research.
OBJECTIVE: Investigation of variations in provider performance and its determinants may help inform strategies for improving patient outcomes. METHODS: We used the National Heart Failure Audit comprising 68 772 patients with heart failure with reduced left ventricular ejection fraction (HFREF), admitted to 185 hospitals in England and Wales (2007-2013). We investigated hospital adherence to three recommended key performance measures (KPMs) for inhospital care (ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on discharge, β-blockers on discharge and referral to specialist follow-up) individually and as a composite performance score. Hierarchical regression models were used to investigate hospital-level variation. RESULTS: Hospital-level variation in adherence to composite KPM ranged from 50% to 97% (median 79%), but after adjustments for patient characteristics and year of admission, only 8% (95% CI 7% to 10%) of this variation was attributable to variations in hospital features. Similarly, hospital prescription rates for ACE-I/ARB and β-blocker showed low adjusted hospital-attributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and β-blocker, respectively). Referral to specialist follow-up, however, showed larger variations (median 81%; range; 20%, 100%) with 26% of this being attributable to hospital-level differences (CI 22% to 31%). CONCLUSION: Only a small proportion of hospital variation in medication prescription after discharge was attributable to hospital-level features. This suggests that differences in hospital practices are not a major determinant of observed variations in prescription of investigated medications and outcomes. Future healthcare delivery efforts should consider evaluation and improvement of more ambitious KPMs.
No takes yet. Share an insight, caveat, or question.
Emdin et al. (2016) conducted an observational in Heart failure with reduced left ventricular ejection fraction (HFREF) (n=68,772). Guideline-recommended in-hospital care (ACE-I/ARB, beta-blockers, specialist follow-up) was evaluated on Hospital-level variation in adherence to composite key performance measures (Intraclass correlation coefficient) (ICC 8%, 95% CI 7%-10%). Only 8% of the total variation in hospital adherence to a composite of key performance measures for heart failure management was attributable to hospital-level features.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: