Abstract 19608: Public Report Cards Associated With Decreased Heart Failure Readmissions in the Effect Study
Background: Public reporting of hospital performance on in-hospital heart failure (HF) quality indicators is increasingly common although its effectiveness in reducing HF readmissions is uncertain. We conducted an analysis of data from the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) (clinicaltrials.gov NCT00187460) cluster randomized trial of cardiac report cards to evaluate the hypothesis that public reporting of hospital performance might be associated with reduced HF readmission rates.
Methods: Patients included in this post-hoc analysis (n=7,399) were those hospitalized for an index episode of HF identified as part of the follow-up cohort in the EFFECT study, conducted in Ontario, Canada. Participating Ontario hospital corporations (n=86) were randomized to early (January 2004) or delayed feedback (September 2005) of a report card on their baseline performance (1999 to 2001) on a set of 6 process-of-care indicators for HF. Follow-up data were collected between April 2004 and March 2005. The primary outcome for this analysis was the readmission rate for HF. Subgroup analyses were conducted in those patients with reduced ejection fraction.
Results: There was no significant difference in HF readmission rates overall between the two study arms. Among patients with reduced ejection fraction (n=2,322), readmission for HF was 20% lower for those treated in the early feedback arm compared to the delayed feedback arm at 1 year (21.4% vs. 26.8%; p=0.001), and this persisted through 4 years of follow-up (34.1% vs. 38.8%; p=0.023). Patients (without contraindications) with reduced ejection fraction treated in the early feedback hospitals were more likely to be prescribed angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker at discharge compared to those in the delayed feedback group (90.0% vs. 86.6%; p=0.004). These patients were also more frequently prescribed an ACE inhibitor dose that was near-equivalent to target doses proven effective in clinical trials (44.3% vs. 39.6%; p=0.030).
Conclusions: Public release of hospital-specific quality indicators was associated with lower HF readmission rates for HF patients with reduced ejection fraction.
- © 2010 by American Heart Association, Inc.