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JACC Heart Fail. 2013 Aug;1(4):318-24. doi: 10.1016/j.jchf.2013.04.005. Epub 2013 Aug 5.

Patterns of change in nesiritide use in patients with heart failure: how hospitals react to new information.

Author information

  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut. Electronic address: chohrehpartovi@gmail.com.
  • 2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
  • 3Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Comparative Effectiveness Research, Yale University School of Medicine, New Haven, Connecticut.
  • 4Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
  • 5Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
  • 6Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.

Abstract

OBJECTIVES:

This study sought to determine hospital patterns of change in use of nesiritide over a 6-year period after publications of safety concerns in 2005 and to identify hospital characteristics associated with these patterns.

BACKGROUND:

The changing nature of medical evidence often requires a change in practice. Nesiritide was commercialized in 2001 for early relief of dyspnea in patients with decompensated heart failure. In 2005, concerns about its safety led to recommendations to restrict its use. Little is known about how hospitals responded to this information.

METHODS:

We analyzed data from the Premier database, including 403 hospitals contributing 813,783 hospitalizations with heart failure from 2005 to 2010. We applied a growth mixture modeling approach to hospital-level, risk-standardized, quarterly use rates of nesiritide to distinguish hospital groups on the basis of their patterns of change in use.

RESULTS:

The proportion of hospitalizations using nesiritide declined from 15.4% in 2005 to 1.2% in 2010. The level and speed of change varied markedly among hospitals. After adjusting for differences in patient characteristics across hospitals and years, we identified 3 distinct groups of hospitals: "low users," "fast de-adopters," and "slow de-adopters." In multivariate regression analysis, these groups did not differ in traditional hospital characteristics, such as size, urban setting, or teaching status.

CONCLUSIONS:

We identified 3 distinct hospital groups characterized by their patterns of change in nesiritide use. These trajectory curves can provide hospitals with important feedback on how fast and effectively they react to new information compared with other hospitals. Uncovering factors that promote organizational learning requires further research.

Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

drug use; heart failure; hospital; organizational learning; practice patterns; response to new evidence

PMID:
24621935
[PubMed - indexed for MEDLINE]
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