title: Hospital-level performance improvement: beta-blocker use after acute myocardial infarction.
abstract: BACKGROUND
  National surveys indicate improvement in beta-blocker use after acute myocardial infarction (AMI) over time; however, these data could obscure important variation in improvement at individual hospitals. Our objective was to characterize the hospital-level variation in the improvements in beta-blocker prescription rates after AMI and to identify hospital characteristics that were associated with hospital improvement rates after adjustment for patient demographic and clinical characteristics.
  
  
  RESULTS
  We used data (n = 335,244 patients with AMI discharged from 682 hospitals) from the National Registry of Myocardial Infarction (NRMI) and from the American Hospital Association Annual Survey of Hospitals and hierarchical modeling to examine the associations between hospital characteristics and hospital-level rates of change in beta-blocker use during 1996-1999. On average, hospital rates of beta-blocker use for patients with AMI increased 5.9 percentage points (standard deviation, 9.7 percentage points) from the premidpoint time period (April 1996-February 1998) to the postmidpoint time period (March 1998-September 1999) of the study. The range in hospital-level changes in beta-blocker rates was substantial, from a decline of -50.0 percentage points to an increase of +35.7 percentage points. AMI volume and teaching status, geographic region, and initial beta-blocker use rates were associated with rate of improvement, but the magnitude of these effects was modest.
  
  
  CONCLUSIONS
  The study reveals marked hospital-level variation in improvement in beta-blocker use after AMI. Several hospital characteristics were associated with this improvement, but they are weak predictors of hospital-based improvement in the use of beta-blockers.
authors.affiliation: Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Mattera
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Paul
authors.initials: P
authors.lastname: Frederick
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Roumanis
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Radford
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000573:American Hospital Association; D016507:Cardiology Service, Hospital / Q000145:classification / Q000592:standards*; D015897:Comorbidity; D017723:Drug Utilization Review; D005260:Female; D005843:Geography; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D010351:Patient Discharge; D011785:Quality Assurance, Health Care; D012042:Registries; D012959:Socioeconomic Factors; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists