Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure
Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure
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DOI：
10.1016/j.ahj.2009.07.031
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发表时间：
2009-10-01
影响因子：
4.8
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Heidenreich, Paul A.;Lewis, William R.;Fonarow, Gregg C.
背景 许多参加美国心脏协会的遵循指南 (GWTG) 计划的医院都对心力衰竭、急性心肌梗死 (MI) 和中风提供了高水平的推荐护理。然而，尚不清楚那些获得 GWTG 计划认可的医院的护理流程是否会取得更好的结果。 方法 我们使用医疗保险和医疗补助服务中心报告的心力衰竭和急性心肌梗死风险调整后 30 天生存数据，将加入 GWTG 并因高水平推荐护理流程而获得成就奖的医院与其他医院进行比较。结果 在拥有医疗保险和医疗补助服务中心报告的 30 天数据的 3,909 家医院中 355 (9%) 获得 GWTG 成就奖。与未获奖医院相比，获奖医院心力衰竭（11.0% vs 11.2%，P = .0005）和急性心肌梗死（16.1% vs 16.5%，P < .0001）的风险调整死亡率均较低。对医院特征和非心脏性能指标进行额外调整后，GWTG 获奖医院急性心肌梗死死亡率的降低仍然显着较低（-0.19%，95% CI -0.33 至 -0.05），但心力衰竭死亡率的降低则不然（-0.11%，95% CI -0.25 至 0.02）。对心脏护理过程的额外调整使获奖医院的心力衰竭死亡率和急性心肌梗死死亡率分别降低了 28% 和 43%。 结论 接受 GWTG 计划成就奖的医院急性心肌梗死和心力衰竭的风险调整死亡率略有降低，部分原因是更好的护理过程。 （Am Heart J 2009；158：546-53。）
Background Many hospitals enrolled in the American Heart Association's Get With The Guidelines (GWTG) Program achieve high levels of recommended care for heart failure, acute myocardial infarction (MI) and stroke. However, it is unclear if outcomes are better in those hospitals recognized by the GWTG program for their processes of care.Methods We compared hospitals enrolled in GWTG and receiving achievement awards for high levels of recommended processes of care with other hospitals using data on risk-adjusted 30-day survival for heart failure and acute MI reported by the Center for Medicare and Medicaid Services.Results Among the 3,909 hospitals with 30-day data reported by Center for Medicare and Medicaid Services 355 (9%) received GWTG achievement awards. Risk-adjusted mortality for hospitals receiving awards was lower for both heart failure (11.0% vs 11.2%, P = .0005) and acute MI (16.1% vs 16.5%, P < .0001) compared to those not receiving awards. After additional adjustment for hospital characteristics and noncardiac performance measures, the reduction in mortality remained significantly lower for GWTG award hospitals for acute myocardial infraction (-0.19%, 95% CI -0.33 to -0.05), but not for heart failure (-0.11%, 95% CI -0.25 to 0.02). Additional adjustment for cardiac processes of care reduced the benefit of award hospitals by 28% for heart failure mortality and 43% for acute MI mortality.Conclusions Hospitals receiving achievement awards from the GWTG program have modestly lower risk adjusted mortality for acute MI and to a lesser extent, heart failure, explained in part by better process of care. (Am Heart J 2009; 158:546-53.)