Variations among hospitals in the quality of care for heart failure.
BACKGROUND
Determining variations in quality of care among hospitals can help direct attention to poorly performing institutions.


METHODS
The proportion of patients with congestive heart failure meeting various quality criteria in 69 hospitals. HOSPITAL SELECTION: The hospitals were voluntary participants in a quality improvement program in five states (Colorado, Connecticut, Georgia, Oklahoma, and Virginia).


METHODS
All patients with congestive heart failure discharged from the participating hospitals during a 15-month period in 1995 to 1996 (or, for hospitals with more than 50 eligible patients, a random sample of 50 patients). The total sample consisted of 2077 patients.


METHODS
Documentation in the hospital medical record of left ventricular function, discharge medications, and discharge instructions.


RESULTS
Left ventricular function was determined in 72% of patients (range across hospitals, 18% to 97%). Among patients with left ventricular systolic dysfunction, 79% were prescribed an angiotensin-converting enzyme inhibitor (range, 54% to 94%). Only 23% of the patients prescribed angiotensin-converting enzyme inhibitors received the target dose (range, 0% to 60%). Sixty-four percent of patients were counseled about the importance of a low-sodium diet at discharge (range, 25% to 97%), but only 8% were counseled about daily weight monitoring (range, 0% to 30%).


CONCLUSIONS
Our results show substantial hospital-to-hospital variation in the quality of care for patients with heart failure.
Kerr L. White Institute for Health Services Research, Decatur, Ga., USA.
J C
JC
Luthi
W M
WM
McClellan
D
D
Fitzgerald
J
J
Herrin
R J
RJ
Delaney
H M
HM
Krumholz
D W
DW
Bratzler
K
K
Elward
C B
CB
Cangialose
D J
DJ
Ballard
D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006334:Heart Function Tests; D006801:Humans; D008297:Male; D008485:Medical Audit; D006278:Medicare; D010343:Patient Admission; D011787:Quality of Health Care; D014481:United States