What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). Intervention: High adherence (50-100%) to National Hospital Quality Measures vs. Low adherence (0-49%). Primary outcome: Long-term mortality and readmissions.

What does this research mean for the field?

Adherence of 50-100% to National Hospital Quality Measures for acute myocardial infarction and pneumonia is associated with superior survival and freedom from readmission compared to 0-49% adherence, whereas adherence to heart failure measures yields inconsistent outcomes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To evaluate the association between adherence to National Hospital Quality Measures and long-term mortality and readmissions for acute myocardial infarction, heart failure, and pneumonia.

March 2, 2012BMJ Quality & SafetyOpen Access

Association of National Hospital Quality Measure adherence with long-term mortality and readmissions

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Key result

Adherence of 50-100% to National Hospital Quality Measures for AMI and pneumonia was associated with superior survival and freedom from readmission compared to 0-49% adherence.

Why the study?

Does higher adherence to National Hospital Quality Measures reduce long-term mortality and readmissions in patients with AMI, HF, or pneumonia?

Population

Patients discharged from Massachusetts General Hospital between 1 July 2004 and 31 December 2007 with a…

Comparison

High adherence to National Hospital Quality… vs Low adherence to National Hospital Quality…

Design

Cohort

Follow-up

at least 1 year

Authors

DSDavid M. ShahianCardiac Surgery GMGregg S. MeyerHarvard University EMElizabeth MortBrigham and Women's Hospital

Discussion

Member takes

Implication

Supports quality measure adherence for AMI/pneumonia; leaves open HF applicability and causal impact.

Key Points

To evaluate the association between adherence to National Hospital Quality Measures and long-term mortality and readmissions for acute myocardial infarction, heart failure, and pneumonia.
Analyzed patients discharged between July 1, 2004, and December 31, 2007, with acute myocardial infarction, heart failure, or pneumonia eligible for quality measures (N=374 to 3,020 per measure).
Followed patients for at least 1 year by linking hospital records with state administrative registries to assess mortality and readmission.
Modeled time-weighted measure failures via exponential decay functions and estimated hazard ratios using Cox models adjusted for Elixhauser comorbidities, sociodemographics, and do-not-resuscitate orders.
Adherence rates of 100% and 50–99% were associated with superior adjusted survival and freedom from readmission compared to 0–49% adherence for acute myocardial infarction and pneumonia.
Heart failure process measures showed inconsistent and sometimes paradoxical associations with outcomes, though specific therapies such as ACE inhibitors or angiotensin receptor blockers improved survival.

Study Design

Type

Cohort

Multicenter

Structured PICO

Does higher adherence to National Hospital Quality Measures reduce long-term mortality and readmissions in patients with AMI, HF, or pneumonia?

Population

Patients discharged from Massachusetts General Hospital between 1 July 2004 and 31 December 2007 with a principal diagnosis of acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN) who were eligible for at least one National Hospital Quality Measure (n=374 to 3020 depending on measure).

Intervention

High adherence (100% and 50-99%) to National Hospital Quality Measures.

Comparator

Low adherence (0-49%) to National Hospital Quality Measures.

Outcome

Long-term mortality and readmissions.hard clinical

Adherence to recommended hospital care processes is associated with improved long-term outcomes for AMI and pneumonia, but the association is inconsistent for heart failure, questioning the suitability of some HF measures for accountability.

Cite This Study

Shahian et al. (2012) conducted a cohort in Acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). High adherence (50-100%) to National Hospital Quality Measures vs. Low adherence (0-49%) was evaluated on Long-term mortality and readmissions. Adherence of 50-100% to National Hospital Quality Measures for AMI and pneumonia was associated with superior survival and freedom from readmission compared to 0-49% adherence.

synapsesocial.com/papers/6a164530512cb4f7828ead69 https://doi.org/10.1136/bmjqs-2011-000615

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Association of National Hospital Quality Measure adherence with long-term mortality and readmissions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Association of National Hospital Quality Measure adherence with long-term mortality and readmissions

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Also Consider