Abstract 1287: The Impact of Different Ranking Methods for Hospital’s Heart Failure Quality of Care: Results From the AHA’ s Get With the Guidelines-Heart Failure Registry
BACKGROUND: Both process and outcome heart failure (HF) measures have been used to quantify hospital quality of care. However, it is unknown how well these measures correlate with 30-day outcomes or whether hospital rankings shift based on the method of quality measurement.
METHODS: Heart failure (HF) patients 65 years and older who were hospitalized in the American Heart Association’s Get With the Guidelines-HF registry were linked to Medicare claims from 2005– 06. Hospitals with <15 cases were excluded. Hospitals were ranked by deciles using composite scores for process measures (discharge instructions, LVEF documentation, smoking cessation counseling, ACEI/ARB for LVSD and beta-blocker for LVSD). Similarly, hospitals were ranked by risk-adjusted outcomes (30-day death after admission, 30-day readmission after discharge) using hierarchical models and shrinkage estimates to account for case-mix and hospital volume.
RESULTS: There were 19,483 patients hospitalized from 2005– 06 from 153 hospitals. Overall adherence rate across the 5 process measures was 85.1. Median risk-adjusted 30-day mortality from day of admission was 9.0%. Median risk-adjusted 30-day readmission was 22.9%. Median shift of hospital ranking using 30-day mortality versus 30-day readmission was 33 (25th/75th Interquartile range (IQR) 13, 68); 30-day mortality versus process measures was 51 (25th/75th IQR 22, 76). Overall there was poor correlation to the different measures of ranking quality of care (TABLE⇓).
CONCLUSIONS: Agreement between different methods of ranking hospital-based quality of care and 30-day mortality or readmission rankings is poor. Measuring quality of care will likely require additional measures and/or multi-dimensional ranking methods.
This research has received full or partial funding support from the American Heart Association, National Center.