Variations in the quality of care of patients with acute myocardial infarction among Swiss university hospitals.
OBJECTIVE
The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial infarction (AMI) patients among three Swiss academic medical centres.


METHODS
Cross-sectional study.


METHODS
Three Swiss university hospitals.


METHODS
We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or secondary diagnosis code [International Classification of Diseases, 10th revision (ICD-10)] of AMI. We abstracted medical records for information on demographic characteristics, risk factors, symptoms, and findings at admission. We also recorded the main ECG and laboratory findings, as well as hospital and discharge management and treatment. We excluded patients transferred to another hospital and who did not meet the clinical definition of AMI.


METHODS
Percentage of patients receiving appropriate intervention as defined by six quality of care indicators derived from clinical practical guidelines.


RESULTS
Among 577 eligible patients with AMI in this study, the mean (SD) age was 68.2 (13.9), and 65% were male. In the assessment of the quality indicators we excluded patients who were not eligible for the procedure. Among cohorts of 'ideal candidates' for specific interventions, 64% in hospital A and 73% in hospital C had reperfusion within 12 hours either with thrombolytics or percutaneous transluminal coronary angioplasty (P = 0.367). Further, in hospitals A, B, and C, respectively 97, 94, and 84% were prescribed aspirin during the initial hospitalization (P = 0.0002), and respectively 68, 91, and 75% received angiotensin converting enzyme inhibitors at discharge in the case of left ventricular systolic dysfunction (P = 0.003).


CONCLUSIONS
Our results showed important hospital-to-hospital variations in the quality of care provided to patients with AMI between these three university hospitals.
Luthi
Jean-Christophe
JC
Georgia Medical Care Foundation, Atlanta, GA, USA. jean-christophe.luthi@inst.hospvd.ch
McClellan
William M
WM
Flanders
W Dana
WD
Pitts
Stephen R
SR
Burnand
Bernard
B
D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D006779:Hospitals, Public / Q000592:standards; D006785:Hospitals, University / Q000458:organization & administration / Q000592:standards*; D006786:Hospitals, Urban / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D013557:Switzerland; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin