Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure.
BACKGROUND
Many hospitals enrolled in the American Heart Association's Get With The Guidelines (GWTG) Program achieve high levels of recommended care for heart failure, acute myocardial infarction (MI) and stroke. However, it is unclear if outcomes are better in those hospitals recognized by the GWTG program for their processes of care.


METHODS
We compared hospitals enrolled in GWTG and receiving achievement awards for high levels of recommended processes of care with other hospitals using data on risk-adjusted 30-day survival for heart failure and acute MI reported by the Center for Medicare and Medicaid Services.


RESULTS
Among the 3,909 hospitals with 30-day data reported by Center for Medicare and Medicaid Services 355 (9%) received GWTG achievement awards. Risk-adjusted mortality for hospitals receiving awards was lower for both heart failure (11.0% vs 11.2%, P = .0005) and acute MI (16.1% vs 16.5%, P < .0001) compared to those not receiving awards. After additional adjustment for hospital characteristics and noncardiac performance measures, the reduction in mortality remained significantly lower for GWTG award hospitals for acute myocardial infraction (-0.19%, 95% CI -0.33 to -0.05), but not for heart failure (-0.11%, 95% CI -0.25 to 0.02). Additional adjustment for cardiac processes of care reduced the benefit of award hospitals by 28% for heart failure mortality and 43% for acute MI mortality.


CONCLUSIONS
Hospitals receiving achievement awards from the GWTG program have modestly lower risk adjusted mortality for acute MI and to a lesser extent, heart failure, explained in part by better process of care.
Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA. heiden@stanford.edu
Paul A
PA
Heidenreich
William R
WR
Lewis
Kenneth A
KA
LaBresh
Lee H
LH
Schwamm
Gregg C
GC
Fonarow
D019985:Benchmarking; D019983:Guideline Adherence / Q000592:standards*; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology