CVD care improved across US hospitals from 2009 to 2013

The quality of care for patients with MI, HF, stroke and venous thromboembolism has improved across hospitals in the United States in recent years, according to an annual report by The Joint Commission.

“America’s Hospitals: Improving Quality and Safety – The Joint Commission’s Annual Report 2014” evaluated the quality of care at hospitals accredited by The Joint Commission. The report includes accountability measures for MI care, HF care, VTE care, stroke care, pneumonia care, surgical care, pediatric asthma care, perinatal care, inpatient psychiatric services and immunization. For each category, The Joint Commission assessed both individual performance measures and an overall composite of all relevant measures. The results for each performance measure were determined by dividing the number of times a hospital met a given performance measure by the number of opportunities to do so during the course of the year, according to the report.

MI care

From 2009 to 2013, The Joint Commission reported a 1.3% improvement in the composite of relevant performance measures across an average of 2,348 accredited hospitals, from 97.7% in 2009 to 99% in 2013. Percentage improvements from 2009 to 2013 for individual performance measures were as follows:

Aspirin upon patient arrival: 1% (from 98.4% to 99.4%);
Aspirin at discharge: 0.9% (from 98.4% to 99.3%);
ACE inhibitor or angiotensin receptor blocker at discharge: 2.6% (from 95.5% to 98.1%);
Beta-blocker at discharge: 0.9% (from 98.3% to 99.2%);
Administration of fibrinolytic therapy within 30 minutes of hospitalization: 5.1% (from 55.2% to 60.3%);
PCI therapy within 90 minutes of hospitalization: 8.6% (from 87.4% to 96%);
Statin prescription upon patient discharge: 1.1% improvement from 2011 to 2013 (from 97.5% to 98.6%).

HF care

Across an average of 2,601 hospitals, the sole evaluated measure of HF care — administration of an ACE inhibitor or angiotensin receptor blocker at discharge — increased by 3.1%, from 94.3% in 2009 to 97.4% in 2013.

VTE care

Across an average of 88 hospitals with data since 2010, The Joint Commission reported an improvement of 10.2% for a composite of performance measures, from 82.7% in 2010 to 92.9% in 2013. Changes to individual measures from 2010 to 2013 were as follows:

Administration of VTE medication or treatment: 5.8% (from 84.5% to 92.2%);
VTE medication or treatment in the ICU: 5% (from 89.5% to 95.6%);
Overlap therapy in patients with VTE: 14.9% (from 80.7% to 96.3%);
Unfractionated heparin monitoring in patients with VTE: 10% (from 88.8% to 98.1%);
VTE warfarin discharge instructions: 28.6% (from 53.7% to 85.9%).

Although not included in the composite care measure, the incidence of potentially preventable VTE across reporting hospitals decreased by 9.1%, from 13.3% in 2010 to 6.2% in 2013, The Joint Commission noted.

Stroke care

Across an average of 158 hospitals with data since 2010, The Joint Commission reported an increase of 4.3% in the composite measure for stroke care, from 92.7% in 2010 to 97% in 2013. Improvements to individual performance measures were as follows:

Administration of anticoagulation therapy to patients with atrial fibrillation/atrial flutter: 2.2% (from 94.2% to 96.4%);
Antithrombotic therapy administered within 2 days of hospitalization: 1.2% (from 97.3% to 98.5%);
Patients assessed for rehabilitation: 1.6% (from 97% to 98.6%);
Patients discharged on antithrombotic therapy: 0.5% (from 98.7% to 99.2%);
Patients discharged on statins: 3.9% (from 92.8% to 96.7%);
Stroke education: 11.3% (from 82.1% to 93.4%);
Administration of thrombolytic therapy: 18.1% (from 61% to 79.1%);
Administration of VTE medicine/treatment: 8% (from 88.1% to 96.1%).

For more information:

The Joint Commission. America’s Hospitals: Improving Quality and Safety – The Joint Commission’s Annual Report 2014. Available at: http://www.jointcommission.org/annualreport.aspx. Accessed on Dec. 8, 2014.