Decreased in-hospital deaths
associated with adherence to treatment guidelines
Newswise — Receiving care at a
hospital with higher adherence to guidelines for treatment of
patients with acute coronary syndromes is associated with a
decreased likelihood of in-hospital death, according to a study in
the April 26 issue of JAMA.
Assessing quality in health care
has become increasingly important in current medical practice,
according to background information in the article. Government
agencies, professional societies, accreditation organizations and
major insurers have published performance guidelines. The American
College of Cardiology/American Heart Association (ACC/AHA) have
established national clinical practice guidelines for the
appropriate care of patients with non – ST-segment elevation (NSTE -
a certain pattern on an electrocardiogram) myocardial infarction (MI
– heart attack) acute coronary syndrome (ACS - the development of
chest pain of cardiac nature).
Eric D. Peterson, M.D., M.P.H.,
from Duke University Medical Center, Durham, N.C., and colleagues
examined how well hospitals followed ACC/AHA guideline
recommendations for treating patients with NSTE ACS using data from
the CRUSADE (Can Rapid Risk Stratification of Unstable Angina
Patients Suppress Adverse Outcomes With Early Implementation of the
ACC/AHA Guidelines) National Quality Improvement Initiative between
Jan.1, 2001, and Sept. 30, 2003. The study included information on
350 academic and nonacademic U.S. medical centers and 64,775
patients.
The researchers found that
overall, the nine ACC/AHA recommended treatments for patients with
NSTE ACS were followed in 74 percent of treatment opportunities.
However, composite adherence scores varied greatly among the
hospitals. Hospitals in the highest adherence group (quartile 4) had
a median adherence score of 82 percent, compared to 63 percent for
hospitals in the lowest group (quartile 1). These guideline
adherence rates were significantly associated with in-hospital
deaths; death rates ranged from 6.31 percent in the lowest adherence
group to 4.15 percent in the highest adherence group. After
adjusting for risk, the researchers found that every 10 percent
increase in composite adherence was associated with a 10 percent
decrease in its patients’ likelihood of in-hospital death.
“Quality of care has been defined
as ‘the degree to which health service for individuals and
populations increase the likelihood of desired health outcomes and
are consistent with current professional knowledge,’” the authors
write. “Our work supports the central hypothesis of hospital quality
improvement; namely, better adherence with evidence-based care
practices will result in better outcomes for patients who are
treated.”
(JAMA. 2006; 295: 1912 – 1920. )