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Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine:
doi: 10.1097/HPC.0b013e3181cdb5a5
Original Article

Regional Differences in Quality of Care and Outcomes for the Treatment of Acute Coronary Syndromes: An Analysis From the Get With the Guidelines Coronary Artery Disease Program

Laskey, Warren MD*; Spence, Nathan MD*; Zhao, Xin BA†; Mayo, Rebecca RN, PhD, MA, CNP*; Taylor, Robert MD*; Cannon, Christopher P. MD‡; Hernandez, Adrian F. MD§; Peterson, Eric D. MD, MPH†§; Fonarow, Gregg C. MD¶

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Abstract

Background: Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown.

Methods: We evaluated the variation in conformity to the American Heart Association Get With The Guidelines–Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary “all-or-none” process performance measure (primary outcome); an “opportunity-based” overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region.

Results: Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the “all-or-none” (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or “opportunity-based” (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest.

Conclusion: Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.

© 2010 Lippincott Williams & Wilkins, Inc.

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