Abstract 12420: Nationwide Center Benchmarking Using a Composite Performance Measure: the French “Haute Autorité de Santé” Experience
Background. Assessment of quality of care aims to improve patient management, but also to detect centers with sub-optimal quality of care. The optimal method for detecting such centers remains to be identified.
Methods. In agreement with healthcare providers, the French national authority for health (Haute Autorité de Santé) decided to assess quality of care in 2008 and 2009 in all 649 French centers admitting acute myocardial infarction (AMI) patients. Only centers admitting more than 30 AMI/year were included. For each center, 60 records were randomly selected, and data were recorded by a dedicated team, independent of the medical department. PMs applicable to all patients were defined as the appropriate prescription at discharge (in the absence of contra indication) of aspirin, clopidogrel, beta-blocker, statins and ACE inhibitor in patients with left ventricular ejection fraction <0.40. The composite indicator was calculated according to the “All or None” method with corresponding 95% confidence interval. Centers were classified into 3 groups based on their position relative to the national mean, namely high, medium and sub-optimal quality.
Results. A total of 275 centers in 2008 and 197 in 2009 participated in the evaluation (14955 patient records in 2008; 10557 in 2009). The national mean of the composite indicator increased from 0.76 in 2008 to 0.81 in 2009. The rate of centers with 95%CI below the threshold was 15.4% in 2008 and 14.9% in 2009 while the rate of centers above the threshold was 28.5% in 2008 and 28.7% in 2009 (figure).
Conclusion. For centers admitting more than 30 AMI per year, the 95%CI of the composite indicator allows classification into three groups reflecting quality of care. This method indentified 15% of French AMI centers as providing sub optimal quality of care.
- © 2011 by American Heart Association, Inc.