Abstract 311: Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest

Abstract

Introduction: Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year. Methods: We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals’ RSSR during 2014-2017 (follow-up). Results: During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4 th (75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile ( > 25 percentile points) at 26.8% and by at least 2 quartiles ( > 50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively. Conclusion: Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.