Abstract 12963: More Than 1 in 10 Centres Caring for Patients with Myocardial Infarction Consistently Perform Badly: Results from Nationwide Assessment of Quality of Discharge Prescription after AMI in France
Background: We report results from 4 consecutive years of a nationwide assessment of quality indicators (QI) at discharge after acute myocardial infarction and the categorization of centres according to performances.
Methods: Nationwide assessment of QI at AMI discharge in France by the National Authority for Health (HAS) from 2008 through 2011. In all centres, data collection was mandatory from up to 60 patient files. Appropriate prescription at discharge of aspirin, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors (ACEI) when left ventricular ejection fraction (LVEF)≤40%, and statins was defined as prescription in eligible patients. A composite indicator (Composite) was computed using the All-or-None method. Centres were categorized as top, middle and lower quality groups according to the 95% Confidence Interval (CI) of the Composite. The number of times a centre was classed in the lowest group was used to determine good (0 times), middle and poor (≥3 times) quality centres.
Results: A total of 52509 files from 272 centres were examined. National average of Composite increased from 67 in 2008 to 84% in 2011. The rate of centres in the top group increased from 7 to 39%, while the rate of centres in the lowest group decreased from 49 to 13% (table). A large proportion of centres (112, 41%) were considered good quality centres, as they were never classified in the lowest group in any of the 4 consecutive campaigns. Conversely, 32 (11.8%) were classified in the poor quality group, based on a 95%CI of the Composite ≤90% in ≥3/4 campaigns.
Conclusions: Repeated classification in lowest quality group after assessment of quality of discharge prescription after AMI identified 11.8% of centres that were consistently categorized as poor performers. These centres are not all low-volume centres, and could justify a detailed audit.
- © 2013 by American Heart Association, Inc.