June 14, 2004Archives of Internal Medicine
Provider and Hospital Characteristics Associated With Geographic Variation in the Evaluation and Management of Elderly Patients With Heart Failure
Why the study?
Do provider and hospital characteristics influence the rates of guideline-based care (LVEF documentation and ACE inhibitor prescription) in elderly patients hospitalized with heart failure?
Population
30,228 Medicare patients older than 65 years hospitalized with heart failure in the United States.
Design
Cohort
Authors
Discussion
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Member takes
Implication
May identify targets to reduce HF care variation; hypothesis-generating for interventions at nonteaching/rural hospitals.
Structured PICO
Do provider and hospital characteristics influence the rates of guideline-based care (LVEF documentation and ACE inhibitor prescription) in elderly patients hospitalized with heart failure?
P
Population
30,228 Medicare patients older than 65 years hospitalized with heart failure in the United States.
I
Intervention
Care at hospitals with specific characteristics (medical school affiliation, invasive cardiac capabilities, rural/urban location, teaching status) and provider characteristics (cardiologist attending)
O
Outcome
Rates of documentation of left ventricular ejection fraction and appropriate prescription of angiotensin-converting enzyme inhibitors
Provider and hospital characteristics, such as teaching status and cardiologist involvement, significantly contribute to geographic variation in guideline-based heart failure care for elderly patients.
Cite This Study
Havranek et al. (2004) studied this question.