The Association between Hospital Quality of Care and Short-Term Mortality of Acute Myocardial Infarction Patients

Abstract

Objectives: To evaluate the association of six hospital-level process of care measures and the 30-day mortality. Methods: This is a cross-sectional study. Patients admitted with a principal diagnosis of AMI (ICD-9CM: 410.xx, excluding 410.x2) (n=1,416) between January 2007 and November 2009. Aspirin use during hospitalization, β-blocker use during hospitalization, ACE inhibitor for LVSD use during hospitalization, LDL-c testing, lipid lowering medication, and reperfusion therapy. Outcome included the 30-day mortality of AMI patients. Data were analysed by using a hierarchical generalized linear model (HGLM) to examine whether the 30-day mortality at the patient level varied among different hospital performance adjusted for patient and hospital characteristics. Results: Among those patients, 88.50% received aspirin therapy during hospitalization, 38.32% received β-blocker therapy, 46.75% received ACE inhibitor for LVSD, 43.91% received LDL-C testing, 41.37% received lipid lowering medication, and 40.97% received reperfusion therapy. Overall the 6 quality of care measures were 53.7% of ideal instances. After risk adjustment, β-blocker use during hospitalization (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.83-0.92), ACE inhibitor for LVSD (OR, 0.93; 95% CI, 0.87-0.99), lipid lowering medication (OR, 0.91; 95% CI, 0.86-0.96), reperfusion therapy (OR, 0.87; 95% CI, 0.81-0.93) and composite score of six measures (OR, 0.84; 95% CI, 0.76-0.92) were significantly correlated with 30-day mortality. Conclusions: A significant association between hospital's process performance and patient outcome was found. The outcome of AMI patients could be enhanced by improving process performance.