Between 1994-1995 and 1998-1999, discharge beta-blocker prescription for Medicare patients with AMI increased from 50.3% to 70.7% (P<0.001), alongside improvements in other evidence-based therapies.
Observational (n=270,467)
Yes
Did evidence-based process of care measures improve for Medicare patients hospitalized with acute myocardial infarction between 1994-1995 and 1998-1999?
Between 1994 and 1999, there were significant national improvements in the prescription of guideline-directed medical therapies for Medicare patients with AMI, though substantial variations and gaps in care remained.
Absolute Event Rate: 70.7% vs 50.3%
p-value: p=<.001
BACKGROUND: National efforts have focused attention on quality of care, but relatively little is known about whether, and to what extent, improvement has occurred during this recent period. Furthermore, the variability of the recent change over time is not known. METHODS: We sought to determine national and state trends in quality of care for Medicare patients hospitalized with acute myocardial infarction (AMI) between 1994-1995 (n = 234754 discharges) and 1998-1999 (n = 35713 discharges) as part of the Centers for Medicare early administration of beta-blocker increased by 17.4 percentage points (51.1% to 68.4%); discharge angiotensin-converting enzyme inhibitor prescription for systolic dysfunction increased by 8.0 percentage points (62.8% to 70.8%); early administration of aspirin increased by 6.6 percentage points (76.4% to 82.9%); and aspirin prescribed at discharge increased by 5.6 percentage points (77.3% to 82.9%) (P<.001 for all categories). Smoking cessation counseling decreased by 3.6 percentage points (40.8% to 37.2%; P<.001). Rates of acute reperfusion therapy did not significantly change (59.2% to 60.6%; P =.35). The median time from hospital arrival to initiation of thrombolytic therapy decreased by 7 minutes (P<.001); and the median time from hospital arrival to initiation of primary percutaneous transluminal coronary angioplasty decreased by 12 minutes (P =.09). CONCLUSIONS: During this 4-year period, quality of care for AMI improved, but substantial variation was observed at both time points. While meaningful population-based improvement has been achieved, ample opportunities for improvement exist. Further work is required to elucidate the strategies associated with improvements in quality of care.
Burwen et al. (2003) conducted an observational in Acute myocardial infarction (AMI) (n=270,467). Care in 1998-1999 vs. Care in 1994-1995 was evaluated on Discharge beta-blocker prescription (p=<.001). Between 1994-1995 and 1998-1999, discharge beta-blocker prescription for Medicare patients with AMI increased from 50.3% to 70.7% (P<0.001), alongside improvements in other evidence-based therapies.