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Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry.
Arch Intern Med. 2005 Jul 11; 165(13):1469-77.AI

Abstract

BACKGROUND

Quality-of-care indicators have been developed for patients hospitalized with heart failure. However, little is known about current rates of conformity with these indicators or their variability across hospitals.

METHODS

Data from 81 142 admissions occurring between July 1, 2002, and December 31, 2003, at 223 academic and non-academic hospitals in the United States participating in the Acute Decompensated Heart Failure National Registry (ADHERE) were analyzed. Rates of conformity with the 4 Joint Commission on Accreditation of Healthcare Organizations core performance measures--discharge instructions (HF-1), assessment of left ventricular function (HF-2), use of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction (HF-3), and smoking cessation counseling (HF-4)--as well as length of stay and in-hospital mortality rates were computed.

RESULTS

Across all hospitals, the median rates of conformity with HF-1, HF-2, HF-3, and HF-4 were 24.0%, 86.2%, 72.0%, and 43.2%, respectively. Rates of conformity at individual hospitals varied from 0% to 100%, with statistically significant differences between academic and non-academic hospitals. Statistically significant positive independent predictors of overall conformity included the prevalence of comorbidities and the use of more intense pharmacologic management. Median hospital length of stay varied from 2.3 to 9.5 days, and in-hospital mortality varied from 0% to 11.1%.

CONCLUSIONS

Among hospitals providing care for patients with heart failure, there is significant individual variability in conformity to quality-of-care indicators and clinical outcomes and a substantial gap in overall performance. Establishing educational initiatives and quality improvement systems to reduce this variability and eliminate this gap would be expected to substantially improve the care of these patients.

Authors+Show Affiliations

Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, The David Geffen School of Medicine at University of California, Los Angeles 90095, USA. gfonarow@mednet.ucla.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16009861

Citation

Fonarow, Gregg C., et al. "Adherence to Heart Failure Quality-of-care Indicators in US Hospitals: Analysis of the ADHERE Registry." Archives of Internal Medicine, vol. 165, no. 13, 2005, pp. 1469-77.
Fonarow GC, Yancy CW, Heywood JT, et al. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch Intern Med. 2005;165(13):1469-77.
Fonarow, G. C., Yancy, C. W., & Heywood, J. T. (2005). Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Archives of Internal Medicine, 165(13), 1469-77.
Fonarow GC, et al. Adherence to Heart Failure Quality-of-care Indicators in US Hospitals: Analysis of the ADHERE Registry. Arch Intern Med. 2005 Jul 11;165(13):1469-77. PubMed PMID: 16009861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. AU - Fonarow,Gregg C, AU - Yancy,Clyde W, AU - Heywood,J Thomas, AU - ,, PY - 2005/7/13/pubmed PY - 2005/8/27/medline PY - 2005/7/13/entrez SP - 1469 EP - 77 JF - Archives of internal medicine JO - Arch Intern Med VL - 165 IS - 13 N2 - BACKGROUND: Quality-of-care indicators have been developed for patients hospitalized with heart failure. However, little is known about current rates of conformity with these indicators or their variability across hospitals. METHODS: Data from 81 142 admissions occurring between July 1, 2002, and December 31, 2003, at 223 academic and non-academic hospitals in the United States participating in the Acute Decompensated Heart Failure National Registry (ADHERE) were analyzed. Rates of conformity with the 4 Joint Commission on Accreditation of Healthcare Organizations core performance measures--discharge instructions (HF-1), assessment of left ventricular function (HF-2), use of angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction (HF-3), and smoking cessation counseling (HF-4)--as well as length of stay and in-hospital mortality rates were computed. RESULTS: Across all hospitals, the median rates of conformity with HF-1, HF-2, HF-3, and HF-4 were 24.0%, 86.2%, 72.0%, and 43.2%, respectively. Rates of conformity at individual hospitals varied from 0% to 100%, with statistically significant differences between academic and non-academic hospitals. Statistically significant positive independent predictors of overall conformity included the prevalence of comorbidities and the use of more intense pharmacologic management. Median hospital length of stay varied from 2.3 to 9.5 days, and in-hospital mortality varied from 0% to 11.1%. CONCLUSIONS: Among hospitals providing care for patients with heart failure, there is significant individual variability in conformity to quality-of-care indicators and clinical outcomes and a substantial gap in overall performance. Establishing educational initiatives and quality improvement systems to reduce this variability and eliminate this gap would be expected to substantially improve the care of these patients. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16009861/Adherence_to_heart_failure_quality_of_care_indicators_in_US_hospitals:_analysis_of_the_ADHERE_Registry_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.165.13.1469 DB - PRIME DP - Unbound Medicine ER -