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APHA Scientific Session and Event Listing

Recorded presentation

Darryl T. Gray, MD, ScD, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, (301) 427-1326, darryl.gray@ahrq.hhs.gov

Introduction: The Agency for Healthcare Research and Quality (AHRQ)'s annual NHQR tracks changes in the quality of health care provided for several key conditions. This abstract describes 2005 NHQR data from the Medicare Quality Improvement Organization (QIO) Program on process measures of the quality of inpatient care provided for AMI patients, along with mortality data from AHRQ's Nationwide Inpatient Sample (NIS). Methods: Within states and equivalent jurisdictions, the QIO Program annually reviews medical records of stratified random samples of up to 750 fee-for-service Medicare discharges for AMI. Data abstracted include receipt of widely recommended care components not contraindicated in individual patients. AMI care components include: aspirin administered within 24 hours of hospital arrival and at discharge, beta-blockers administered within 24 hours of arrival and at discharge, angiotensin-converting enzyme (ACE) inhibitors administered to patients with left ventricular systolic dysfunction, and smoking cessation counseling provided to smokers. Composite measures assess the total proportion of times that inpatients receive individual care components for which they are eligible. For AMI patients meeting specific criteria, time intervals from hospital arrival to receipt of thrombolytic therapy or percutaneous coronary intervention (PCI) are also measured. NIS nationwide estimates reflect data on AMI discharges (excluding transfers out) from weighted stratified samples of non-federal hospitals. Results: The provision of aspirin at discharge, beta-blockers initially and at discharge, and smoking cessation counseling all increased from 2000/2001 to 2003. Initial aspirin use rose slightly. Use of listed ACE inhibitors fell from 73.9% to 68.2%, possibly reflecting increasing use of (unlisted) angiotensin receptor blockers. Nationally, the composite measure score rose from 77.2% in 2000/2001 to 82.1% in 2003. The listed median time to initiation of PCI actually rose from 108 minutes in 2000/2001 to 188 minutes in 2002, falling to 144 minutes in 2003. The median time to initiation of thrombolytic therapy rose from 43 minutes in 2000/2001 to 46 minutes in 2003. Individual states varied considerably in the provision of recommended care components. For inpatients 65+ years old, nationwide adjusted mortality fell from 110.9 deaths/1,000 AMI discharges in 2001 to 103.6/1,000 in 2002 (2003 results pending). Conclusions: The quality of inpatient AMI care for Medicare beneficiaries improved modestly for some but not all process measures, and related inpatient mortality declined somewhat. The variability of results across states and across measures over ~2 years identifies some areas of high-quality performance, along with areas where further improvement is potentially achievable.

Learning Objectives: At the conclusion of the presentation, participant audience members will be able to

• List recommended process measures of the quality of inpatient care for patients with acute myocardial infarction
• Describe nationwide variation in the provision of these care components and of a composite measure for Medicare patients discharged with acute myocardial infarction for 2000/2001 to 200
• Put data on their own states’ performance on these measures into national perspective for identifying potential targets for quality improvement.

Keywords: Health Care Quality, Cardiorespiratory

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation