Do specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: quality of care in cardiac specialty hospitals.
BACKGROUND
Supporters of specialty hospitals claim these facilities provide better patient care; however, empirical data on quality of care in specialty hospitals are limited.


METHODS
We used data reported to the Centers for Medicare and Medicaid Services (CMS) during 2005 to 2006 to compare the quality of care of specialty cardiac hospitals, competing general hospitals and a group of top-ranked cardiac hospitals as identified by the US News & World Report's list of "America's best cardiac hospitals" for acute myocardial infarction (AMI) and heart failure (HF). The main outcome was hospital compliance with CMS performance measures, expressed as the percentage of eligible patients with AMI or HF who received guidelines-based treatment.


RESULTS
The mean compliance for all 179 hospitals was 95% for AMI measures, 91% for HF measures, and 94% for all cardiac care (AMI plus HF measures). Specialty hospitals' compliance with AMI and HF guidelines (95.2% and 91.3%) was similar to that of competing general hospitals (94.7% and 90.5%), whereas top-ranked cardiac hospitals compliance with both AMI and CHF measures (96.8% and 94.1%) was higher (P < .001). In supplemental analyses, we found that 40% of specialty hospitals were ranked in the top quartile of all 179 hospitals, as compared with 22.9% of top-ranked cardiac hospitals. Conversely, 25% specialty hospitals were in the lowest quartile, as compared to 7% of top-ranked cardiac hospitals.


CONCLUSIONS
Quality of care in specialty cardiac hospitals is similar to quality in competing general hospitals and top-ranked cardiac care hospitals, as measured by compliance with AMI and HF performance indicators. Quality of care appears to be slightly better for top-ranked cardiac hospitals as compared to general hospitals, but the overall performance of all hospitals is high.
Popescu
Ioana
I
The Center for Research in Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, IA, USA. ioana-popescu@uiowa.edu
Nallamothu
Brahmajee K
BK
Vaughan-Sarrazin
Mary S
MS
Cram
Peter
P
D002300:Cardiac Care Facilities / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D042241:Early Diagnosis; D005069:Evaluation Studies as Topic; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods* / Q000401:mortality; D011336:Probability; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012042:Registries; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States