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J Am Heart Assoc. 2016 Sep 14;5(9). pii: e003680. doi: 10.1161/JAHA.116.003680.

Identification of Hospital Cardiac Services for Acute Myocardial Infarction Using Individual Patient Discharge Data.

Author information

1
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
2
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University, New Haven, CT Department of Health Policy and Management, School of Public Health, Yale University, New Haven, CT.
3
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
4
Premier Inc, Washington, DC.
5
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Discipline of Medicine, University of Adelaide, South Australia, Australia isuru.ranasinghe@adelaide.edu.au.

Abstract

BACKGROUND:

The availability of hospital cardiac services may vary between hospitals and influence care processes and outcomes. However, data on available cardiac services are restricted to a limited number of services collected by the American Hospital Association (AHA) annual survey. We developed an alternative method to identify hospital services using individual patient discharge data for acute myocardial infarction (AMI) in the Premier Healthcare Database.

METHODS AND RESULTS:

Thirty-five inpatient cardiac services relevant for AMI care were identified using American Heart Association/American College of Cardiology guidelines. Thirty-one of these services could be defined using patient-level administrative data codes, such as International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes. A hospital was classified as providing a service if it had ≥5 instances for the service in the Premier database from 2009 to 2011. Using this system, the availability of these services among 432 Premier hospitals ranged from 100% (services such as chest X-ray) to 1.2% (heart transplant service). To measure the accuracy of this method using administrative data, we calculated agreement between the AHA survey and Premier for a subset of 16 services defined by both sources. There was a high percentage of agreement (≥80%) for 11 of 16 (68.8%) services, moderate agreement for 3 of 16 (18.8%) services, and low agreement (≤50%) for 2 of 16 services (12.5%).

CONCLUSIONS:

The availability of cardiac services for AMI care varies widely among hospitals. Using individual patient discharge data is a feasible method to identify these cardiac services, particularly for those services pertaining to inpatient care.

KEYWORDS:

cardiovascular disease; health services research; myocardial infarction; population

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