Mining gold standards from ivory towers: Quality of care in academic medical centers

Abstract

The focus of this year’s American College of Cardiology Bethesda Conference is the future of academic medical centers and their divisions of cardiology.The topic chosen provides evidence of concern for the academic center’s declining prestige. Some of that prestige had been derived from the undisputed presumption that academic medical centers were the strongholds of quality in clinical care.Today, health care consumers and payers demand evidence rather than presumption of quality. In the absence of such evidence, patient care will continue to shift toward community hospitals, which are often more convenient and less expensive than academic medical centers, or toward for-profit hospitals, which many believe to be more efficient. So the study in this issue by Nohria et al,1 examining process indicators for the treatment of patients hospitalized with heart failure, presents refreshing evidence of the high quality of care practiced within academic centers. For academic centers to capitalize on this potentially differentiating feature, they must document their quality, build upon strengths, and improve in areas of weakness. The authors conclude that the 7 university hospitals surveyed performed “fairly well”with regard to assessing ejection fraction, prescribing angiotensin-converting enzyme (ACE) inhibitors at discharge, and education concerning diet, exercise, and medication compliance. In contrast, there were “opportunities for improvement” in the areas of ACE inhibitor dosing and patient education in relation to daily weights and smoking cessation. Although the study did not directly compare performance of the academic centers with other hospitals, the results regarding ACE inhibitor prescription are considerably better than has been reported across the health care spectrum. For example, in a recent report of the Cardiovascular Health Study,2 a population-based prospective cohort analysis, only approximately 50% of patients with heart failure and a low ejection fraction were receiving an ACE inhibitor.