Abstract 11956: Association of Hospital Myocardial Infarction Volume with Adherence to ACC/AHA Performance Measures: Insights from the NCDR®
Background: Adherence to guideline-based therapy improves patient outcomes after acute myocardial infarction (MI). While hospital MI volume is known to be associated with reperfusion care, the extent to which hospital volume is associated with overall guideline adherence is unknown.
Methods: We studied 486 hospitals treating 249,877 MI patients in ACTION Registry®-GWTG™ between 1/2007 and 3/2011. Hospitals were divided into tertiles based on annual MI volume. Hospital adherence to each ACC/AHA performance and test measure, as well as defect-free care (defined as a patient receiving all eligible and indicated performance measures) was compared between tertiles. We used Spearman correlation to assess the strength of dependence between continuous annual hospital MI volume and performance.
Results: Low, middle, and high volume hospitals had annual median (25, 75th percentile) MI volumes of 68 (38, 88), 161 (134, 197), and 375 (283, 458) patients, respectively. Lower volume hospitals were less likely to be academically affiliated (15 vs. 17 vs. 28%, p=0.005), or to have cardiac surgery capabilities (50 vs. 85 vs. 98%, p<0.001), electronic health records (63 vs. 73 vs. 83%, p=0.048), or dedicated tobacco treatment services (56 vs. 65 vs. 78%, p=0.006) compared with higher volume hospitals. We observed moderate correlation between hospital volume and overall defect-free MI care, varying correlation between volume and individual measure adherence, and higher correlation for existing performance than for test performance measures (Table).
Conclusions: Higher hospital MI volume correlated with better overall quality of MI care, but variably was associated with adherence to individual performance measures. Future research to identify specific hospital practices and resources associated with higher quality of care may help elevate all facets of MI care, regardless of hospital MI patient volume.
- © 2012 by American Heart Association, Inc.