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Good hospital performance linked to better outcomes after acute MI
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Patients who were treated for acute MI at high-performing hospitals showed improved survival benefits in the first 30 days and long term than those treated in low-performing hospitals, researchers found.
“Although several studies have evaluated the association of condition-specific risk-standardized mortality rates with other short-term quality metrics, it is not known whether patients admitted to hospitals that are associated with better short-term outcomes have improved long-term survival,” Emily M. Bucholz, MD, PhD, MPH, and colleagues wrote.
The researchers used data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries, which included patients hospitalized for acute MI from 1994 to 1996.
Included in the analysis were 119,735 patients (mean age, 77 years; 49% women) from 1,824 hospitals. Each hospital was put into one of five strata based on the severity of case mix.
Within each stratum, the life expectancy of patients admitted to high-performing hospitals and those treated in low-performing hospitals were compared. The researchers used 30-day risk-standardized mortality rates to define hospital performance and Cox proportional hazards models to calculate life expectancy.
Bucholz, from the department of medicine at Boston Children’s Hospital, and colleagues wrote that as case-mix severity increased, life expectancy declined, and that as risk-standardized mortality rate quintile increased, life expectancy decreased, “which resulted in significant differences in life expectancy between the high-performing hospitals and the low-performing hospitals.”
For patients in the lowest case-mix stratum, the stratum with the highest expected mortality rate, those treated at high-performing hospitals lived an average of 1.07 years (95% CI, 0.75-1.39) longer than those treated at low-performing hospitals.
For those in the highest case-mix stratum, with the lowest expected mortality rate, life expectancy was 0.83 years (95% CI, 0.63-1.13) longer for those in high-performing hospitals vs. low-performing ones. Although there was variation by case mix, the difference in life expectancy by hospital performance was significant in all five case-mix strata (P < .001), according to the researchers.
When Bucholz and colleagues restricted the analysis to those who survived for 30 days, they found no significant differences in life expectancy by hospital performance within any stratum.
Seven percent of patients survived longer than the 17-year follow-up, making extrapolation of expected survival curves necessary to calculate life expectancy, the researchers wrote.
“Our results suggest that investing in initiatives to improve short-term hospital performance may also improve patient outcomes over the long term,” the researchers wrote. – by Dave Quaile
Disclosure: The researchers report no relevant financial disclosures.
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