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J Am Heart Assoc. 2017 Jun 23;6(6). pii: e005040. doi: 10.1161/JAHA.116.005040.

Quality of Care in Chinese Hospitals: Processes and Outcomes After ST-segment Elevation Myocardial Infarction.

Author information

1
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
2
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
3
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
4
National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
5
University of Colorado Anschutz Medical Campus, Aurora, CO.
6
Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
7
Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City, MO.
8
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT harlan.krumholz@yale.edu.
9
Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT.
10
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.

Abstract

BACKGROUND:

China has gaps in the quality of care provided to patients with ST-elevation myocardial infarction, but little is known about how quality varies between hospitals.

METHODS AND RESULTS:

Using nationally representative data from the China PEACE-Retrospective AMI Study, we characterized the quality of care for ST-elevation myocardial infarction at the hospital level and examined variation between hospitals. Two summary measures were used to describe the overall quality of care at each hospital and to characterize variations in quality between hospitals in 2001, 2006, and 2011. The composite rate measured the proportion of opportunities a hospital had to deliver 6 guideline-recommended treatments for ST-elevation myocardial infarction that were successfully met, while the defect-free rate measured the proportion of patients at each hospital receiving all guideline-recommended treatments for which they were eligible. Risk-standardized mortality rates were calculated. Our analysis included 12 108 patients treated for ST-elevation myocardial infarction at 162 hospitals. The median composite rate increased from 56.8% (interquartile range [IQR], 45.9-72.0) in 2001 to 80.5% (IQR, 74.7-84.8) in 2011; however, substantial variation remained in 2011 with defect-free rates ranging from 0.0% to 76.9%. The median risk-standardized mortality rate increased from 9.9% (IQR, 9.1-11.7) in 2001 to 12.6% (IQR, 10.9-14.6) in 2006 before falling to 10.4% (IQR, 9.1-12.4) in 2011.

CONCLUSIONS:

Higher rates of guideline-recommended care and a decline in variation between hospitals are indicative of an improvement in quality. Although some variation persisted in 2011, very top-performing hospitals missed few opportunities to provide guideline-recommended care. Quality improvement initiatives should focus on eliminating residual variation as well as measuring and improving outcomes.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.

KEYWORDS:

China; hospital performance; quality improvement; quality measurement; variation

PMID:
28645937
PMCID:
PMC5669155
DOI:
10.1161/JAHA.116.005040
[Indexed for MEDLINE]
Free PMC Article

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