A comparison of methods for combining quality and efficiency performance measures: Profiling the value of hospital care following acute myocardial infarction

2008 ◽  
Vol 27 (9) ◽  
pp. 1351-1370 ◽  
Author(s):  
Justin W. Timbie ◽  
Sharon-Lise T. Normand
Author(s):  
Sood Kisra ◽  
John Spertus ◽  
Faraz Kureshi ◽  
Philip G Jones ◽  
Mikhail Kosiborod ◽  
...  

Background: Diabetes mellitus (DM) is common among patients hospitalized with acute myocardial infarction (AMI). Although guideline-supported performance measures exist to improve care for each condition, prior work assessing the quality of care for diabetic patients after AMI has focused only on adherence to CAD performance measures. The quality of diabetic care these patients’ receive is unknown. Methods: Using data from a prospective AMI registry (TRIUMPH), we identified patients with known DM and examined whether DM-focused performance measures had been applied over the 12 months after discharge. We focused upon 3 DM guideline-supported performance measures: a dilated eye exam, detailed foot exam, and HgbA1C testing. For this analysis, we conducted univariate statistics to describe the frequencies with which diabetics reported receiving these DM performance measures and 4 CAD performance measures at their 12-month interview. Results: Among 1,343 patients with a known diagnosis of diabetes presenting with an AMI, a total of 791 (58.9%) completed the 12-month follow up interview. The mean age (SD) of the analytic cohort was 6111 years, with 60% being males and 63% Caucasian. The frequencies of reported receipt among the examined DM and CAD performance measures ranged from 57.3%- 82.2%, with ASA being the most common and a dilated eye exam being the least (Figure). Only 47% of patients reported receiving all three DM performance measures over the past 12 months, while 41.1% reported receiving either one or two, and 12% reported receiving none. Conclusion: In a large, multi-center cohort of diabetic AMI survivors we found that patient-reported receipt of 3 DM and 4 CAD performance measures is sub-optimal and there is significant room for improvement. Novel strategies and approaches for assessing the quality of care delivered to post-AMI diabetics in a multidimensional fashion remains vital for improving care and outcomes in this high-risk group of patients. Characters: 1,683 + figure 500. Limit 2,500


Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Hayato Hosoda ◽  
Atsushi Hirayama ◽  
Yoshio Tahara ◽  
Takahiro Nakashima ◽  
Yu Kataoka ◽  
...  

Background: Whether arrival time is associated with in-hospital managements and outcomes in patients out-of-cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is still unclear. Methods: We conducted a multi-institutional, observational study (JAAM-OHCA study) of OHCA from June 2014 through December 2015 in Japan. The primary exposure was hospital arrival time divided into three groups, defining weekday regular time as 8:00 AM to 4:59 PM, weekday night time as 5:00PM to 7:59AM, and weekends/holidays as Saturday, Sunday and holidays. The outcome measures were in-hospital managements (i.e., percutaneous coronary intervention [PCI], intra-aortic balloon pump [IABP], extracorporeal cardiopulmonary resuscitation [ECPR], and target temperature management [TTM]), and neurologically intact survival at 30-day. To determine the associations of hospital arrival time with these outcomes, we constructed logistic regression models adjusting for patient characteristics, out-of-hospital care and in-hospital care, with generalized estimating equations accounting for patient clustering within hospitals. Results: We recruited 13,491 patients with OHCA. Of these, 852 had return of spontaneous circulation and was diagnosed as AMI; n=299 arrived during weekday regular time; n=265 arrived during weekday night time; n=288 arrived during weekends or holidays. Finally, a total of 219 (25.7%) OHCA patients had neurologically intact survival at 30-day. The rates of in-hospital management were not different among the three groups except IABP use (P<0.01). Compared to patients arrived during weekday regular time, neurologically intact survival rate at 30-day was not significantly different in patients arrived during weekday night time and weekends/holiday (26.1% [78 of 299] in weekday regular time group, 22.6% [60 of 265] in weekday night time group, and 28.1% [81 of 288] in weekends/holidays group) with corresponding adjusted odds ratios of 0.80 (95% confidence interval [CI] 0.45-1.40; P=0.43) and 0.96 (95% CI 0.57-1.63; P=0.89). Conclusion: In this observational study of adult patients with OHCA due to AMI, in-hospital managements and outcomes were not differed across hospital arrival time groups.


2013 ◽  
Vol 35 (2) ◽  
pp. 15-23 ◽  
Author(s):  
David S. Aaronson ◽  
Naomi S. Bardach ◽  
Grace A. Lin ◽  
Arpita Chattopadhyay ◽  
Elizabeth L. Goldman ◽  
...  

Author(s):  
Aurileide Sales da Silva Santos

Trata-se de um estudo que realiza uma discussão a respeito do Infarto Agudo do Miocárdio (IAM). Tendo como objetivo demonstrar qual relevância da atuação da enfermagem diante do paciente acometido pela IAM, assim como, procura descrever o conceito da patologia e identificar os fatores de risco para o desenvolvimento da mesma. O trabalho foi construído mediante pesquisa bibliográfica com abordagem do tipo qualitativa. O IAM trata-se de uma patologia do aparelho cardiovascular, estando associado a fatores como obesidade, sedentarismo, tabagismo e Doenças Crônicas Não Transmissíveis. Em relação ao papel do enfermeiro frente ao paciente com IAM, foi evidenciado que o mesmo atua em diversos momentos da assistência hospitalar, devendo fazer uso da Sistematização da Assistência em Enfermagem (SAE) como forma de garantir a qualidade do atendimento. Ao final percebe-se que o enfermeiro possui um papel muito importante dentro da assistência prestada ao paciente internado vítima de IAM.Descritores: Infarto Agudo do Miocárdio, Enfermeiro, Assistência. Nursing the patient with acute myocardial infarction (AMI)Abstract: This is a study that discusses acute myocardial infarction (AMI). The purpose of this study was to demonstrate the relevance of nursing practice to the patient affected by AMI, as well as to describe the concept of the pathology and to identify the risk factors for its development. The work was constructed through bibliographical research with a qualitative approach. AMI is a pathology of the cardiovascular system, being associated to factors such as obesity, sedentary lifestyle, smoking and Non-Communicable Chronic Diseases. Regarding the role of the nurse in relation to the patient with AMI, it was evidenced that it acts at various moments of hospital care, and should make use of Nursing Care Systematization (SAE) as a way to guarantee the quality of care. At the end of the day nurses have a very important role in the care given to inpatients suffering from acute myocardial infarction.Descriptors: Acute Myocardial Infarction, Nurse, Care. Actuación de la enfermería al paciente con infarto agudo del miocardio (IAM)Resumen: Se trata de un estudio que realiza una discusión acerca del Infarto Agudo del Miocardio (IAM). Con el objetivo de demostrar cual relevancia de la actuación de la enfermería ante el paciente acometido por la IAM, así como, procura describir el concepto de la patología e identificar los factores de riesgo para el desarrollo de la misma. El trabajo fue construido mediante investigación bibliográfica con abordaje del tipo cualitativo. El IAM se trata de una patología del aparato cardiovascular, estando asociado a factores como obesidad, sedentarismo, tabaquismo y enfermedades crónicas no transmisibles. En cuanto al papel del enfermero frente al paciente con IAM, se evidenció que el mismo actúa en diversos momentos de la asistencia hospitalaria, debiendo hacer uso de la Sistematización de la Asistencia en Enfermería (SAE) como forma de garantizar la calidad de la atención. Al final se percibe que el enfermero tiene un papel muy importante dentro de la asistencia prestada al paciente internado víctima de IAM.Descriptores: Infarto Agudo del Miocardio, Enfermero, Asistencia.


Author(s):  
Aurileide Sales da Silva Santos ◽  
Jonas Magno dos Santos Cesário

Trata-se de um estudo que realiza uma discussão a respeito do Infarto Agudo do Miocárdio (IAM). Tendo como objetivo demonstrar qual relevância da atuação da enfermagem diante do paciente acometido pela IAM, assim como, procura descrever o conceito da patologia e identificar os fatores de risco para o desenvolvimento da mesma. O trabalho foi construído mediante pesquisa bibliográfica com abordagem do tipo qualitativa. O IAM trata-se de uma patologia do aparelho cardiovascular, estando associado a fatores como obesidade, sedentarismo, tabagismo e Doenças Crônicas Não Transmissíveis. Em relação ao papel do enfermeiro frente ao paciente com IAM, foi evidenciado que o mesmo atua em diversos momentos da assistência hospitalar, devendo fazer uso da Sistematização da Assistência em Enfermagem (SAE) como forma de garantir a qualidade do atendimento. Ao final percebe-se que o enfermeiro possui um papel muito importante dentro da assistência prestada ao paciente internado vítima de IAM.Descritores: Infarto Agudo do Miocárdio, Enfermeiro, Assistência. Nursing the patient with acute myocardial infarction (AMI)Abstract: This is a study that discusses acute myocardial infarction (AMI). The purpose of this study was to demonstrate the relevance of nursing practice to the patient affected by AMI, as well as to describe the concept of the pathology and to identify the risk factors for its development. The work was constructed through bibliographical research with a qualitative approach. AMI is a pathology of the cardiovascular system, being associated to factors such as obesity, sedentary lifestyle, smoking and Non-Communicable Chronic Diseases. Regarding the role of the nurse in relation to the patient with AMI, it was evidenced that it acts at various moments of hospital care, and should make use of Nursing Care Systematization (SAE) as a way to guarantee the quality of care. At the end of the day nurses have a very important role in the care given to inpatients suffering from acute myocardial infarction.Descriptors: Acute Myocardial Infarction, Nurse, Care. Actuación de la enfermería al paciente con infarto agudo del miocardio (IAM)Resumen: Se trata de un estudio que realiza una discusión acerca del Infarto Agudo del Miocardio (IAM). Con el objetivo de demostrar cual relevancia de la actuación de la enfermería ante el paciente acometido por la IAM, así como, procura describir el concepto de la patología e identificar los factores de riesgo para el desarrollo de la misma. El trabajo fue construido mediante investigación bibliográfica con abordaje del tipo cualitativo. El IAM se trata de una patología del aparato cardiovascular, estando asociado a factores como obesidad, sedentarismo, tabaquismo y enfermedades crónicas no transmisibles. En cuanto al papel del enfermero frente al paciente con IAM, se evidenció que el mismo actúa en diversos momentos de la asistencia hospitalaria, debiendo hacer uso de la Sistematización de la Asistencia en Enfermería (SAE) como forma de garantizar la calidad de la atención. Al final se percibe que el enfermero tiene un papel muy importante dentro de la asistencia prestada al paciente internado víctima de IAM.Descriptores: Infarto Agudo del Miocardio, Enfermero, Asistencia.


Author(s):  
Rosanna Tavella ◽  
Christopher Zeitz ◽  
Margaret Arstall ◽  
Derek Chew ◽  
Matthew Worthley ◽  
...  

Background: Ischemic heart disease is a major contributing factor to the significant mortality and disease burden gap for Indigenous Australians. The current study is a contemporary analysis of Indigenous and non-Indigenous acute myocardial infarction (AMI) patients in regards to clinical features, in-hospital outcomes and performance measures. Methods: All consecutive patients undergoing coronary angiography for AMI in South Australian public hospitals from January 2012 [[Unable to Display Character: &#8211;]] December 2013 were captured. AMI patients (as per Third Universal AMI Definition) were analyzed according to ethnicity (Indigenous/Non-Indigenous). Data was maintained by the Coronary Angiogram Database of South Australia (CADOSA), a comprehensive registry compatible with the NCDR ® CathPCI ® Registry. Results: From 10,469 coronary angiograms performed, the prevalence of Indigenous patients was 4%. The frequency of AMI was higher in Indigenous (n=212) vs. Non-Indigenous (n=3636) patients (50% vs. 36%, p <0.01), despite Indigenous patients being younger by 15 years (50±12 vs. 65±13, p<0.01) and also more likely to be female (41% vs. 29%, p<0.01). Age adjusted analyses revealed a higher prevalence of comorbidities in Indigenous patients including: smoker (66% vs. 34%, p<0.01), hypertension (70% vs. 64%, p<0.01), dyslipidaemia (71% vs. 59%, p<0.01), diabetes (58% vs. 29%, p<0.01), and prior AMI (26% vs. 20%, p<0.01). There were fewer ST elevation myocardial infarcts (STEMI) (33% vs. 39%, p<0.01) but higher rates of hospital transfers (43% 25%, p<0.01) amongst Indigenous patients. Percutaneous coronary intervention (PCI) was less frequently utilized in Indigenous patients (46% vs. 51%, p<0.01), including few Indigenous STEMI patients undergoing primary PCI (18% vs. 53%, <0.01). In-hospital outcomes were similar between Indigenous and non-Indigenous patients, including bleeding complications (0.9% vs. 1.5%, p>0.05) and mortality (2.5% vs. 2.9%, p>0.05), although the relative risk of death adjusted for comorbidities was higher among Indigenous patients (2.7, (0.8-8.0) vs. 0.4, (0.1-1.3,) p>0.05). Discharge therapies were mostly similar in Indigenous vs. non-Indigenous patients including aspirin (91% vs. 84%, p>0.05), beta-blockers (75% vs. 62%, p<0.01), statin (90% vs. 83%, p<0.01), ACE-inhibitor/angiotensin receptor blocker (81% vs. 78%, p>0.05), or referral to cardiac rehab (44% vs. 48%, p>0.05). Conclusion: Indigenous Australians present for angiography with AMI 15 years earlier than non-Indigenous Australians. Despite this, they have a greater incidence of comorbidities, are more often transferred but PCI is less often utilised. Although in-hospital complications do not differ, there is room for improvement given a higher risk of death. Furthermore, evaluation of medication compliance and access to medications post discharge may provide further insight into disease burden.


2013 ◽  
Vol 126 (1) ◽  
pp. 74.e1-74.e9 ◽  
Author(s):  
Dharam J. Kumbhani ◽  
Gregg C. Fonarow ◽  
Christopher P. Cannon ◽  
Adrian F. Hernandez ◽  
Eric D. Peterson ◽  
...  

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