Regional differences in quality of care and outcomes for the treatment of acute coronary syndromes: an analysis from the get with the guidelines coronary artery disease program.
BACKGROUND
Geographic differences in the delivery of guideline-driven care following acute myocardial infarction have been described. The effect of hospital participation in a national performance improvement program on regional variation in quality of care and in-hospital outcomes for acute coronary syndromes (ACS) is unknown.


METHODS
We evaluated the variation in conformity to the American Heart Association Get With The Guidelines-Coronary Artery Disease Program quality measures across 4 geographic regions (Northeast, Midwest, South, and East) in 161,236 patients admitted for ACS to 436 Get With The Guidelines hospitals. We evaluated 6 measures (aspirin within 24 hours, aspirin at discharge, ACEI or ARB therapy for left ventricular systolic dysfunction, beta-blocker at discharge, lipid-lowering medication for qualified patients, smoking cessation advice); a binary "all-or-none" process performance measure (primary outcome); an "opportunity-based" overall composite score (secondary outcome); in-hospital length of stay, and in-hospital mortality. Multivariable logistic regression was performed to test the associations between performance measures and short-term outcomes and geographic region.


RESULTS
Data were collected from January 2, 2000 to January 2, 2008. There was no significant regional variation in either the "all-or-none" (Northeast: 79.3%; Midwest: 83.2%; South: 78.9%; West: 81.6%) or "opportunity-based" (Northeast: 91.9%; Midwest: 93.6%; South: 91.5%; West: 92.6%) composite performance measures. Both performance measures exhibited significant improvement with participation time irrespective of region. In-hospital mortality was similar among regions. Adjusted hospital length of stay was significantly shorter in the Midwest.


CONCLUSIONS
Quality improvement program participation may help to facilitate high quality, consistent care for patients with ACS.
Laskey
Warren
W
Division of Cardiology, Department of Internal Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA. wlaskey@salud.unm.edu
Spence
Nathan
N
Zhao
Xin
X
Mayo
Rebecca
R
Taylor
Robert
R
Cannon
Christopher P
CP
Hernandez
Adrian F
AF
Peterson
Eric D
ED
Fonarow
Gregg C
GC
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D020407:Internet; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology