The Cooperative Cardiovascular Project in Oklahoma.
OBJECTIVE
Acute myocardial infarction is the leading cause of death in the United States and a common cause for admission of Oklahoma Medicare beneficiaries. Based on guidelines for the management of acute myocardial infarction published by a joint committee of the American College of Cardiology and the American Heart Association, the Cooperative Cardiovascular Project was developed by the Health Care Financing Administration to measure performance on quality indicators that describe care provided to Medicare beneficiaries. The objective of the project is to use those performance measures to assist hospitals in the development of quality improvement efforts for acute myocardial infarction care.


METHODS
Retrospective review was performed on the inpatient medical records of 3,436 patients from 102 hospitals in Oklahoma and a random national sample of 2,441 patients discharged with a principal diagnosis of acute myocardial infarction.


RESULTS
The diagnosis of acute myocardial infarction was confirmed in 3,055 (89%) of the cases reviewed. For patients considered to be ideal candidates for an intervention, 62% received reperfusion therapy (thrombolytic or PTCA), 84% received aspirin during the hospitalization, 76% received aspirin at discharge, and 40% received beta-blockers at discharge. There were significant variations in performance between hospital peer groups in the use of reperfusion therapy, aspirin, beta-blockers, and smoking cessation counseling.


CONCLUSIONS
Potentially life-saving treatments for Medicare patients hospitalized with an acute myocardial infarction are often underutilized. Improving quality of care for Medicare beneficiaries with acute myocardial infarction has been identified as a national priority.
Bratzler
D W
DW
Oklahoma Foundation for Medical Quality, Inc., Oklahoma City 73118-9984, USA.
de Leon
A C
AC
Johnson
M C
MC
Oehlert
W H
WH
Slagle
R C
RC
Murray
C K
CK
Bumpus
L J
LJ
Webb
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D014487:Centers for Medicare and Medicaid Services, U.S.; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D009825:Oklahoma / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016540:Smoking Cessation; D014481:United States
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D001241:Aspirin