title: 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.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, MSC10-5550, 1 University of New Mexico, Albuquerque, NM 87131, USA. wlaskey@salud.unm.edu
authors.forename: Warren
authors.initials: W
authors.lastname: Laskey
authors.forename: Nathan
authors.initials: N
authors.lastname: Spence
authors.forename: Xin
authors.initials: X
authors.lastname: Zhao
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mayo
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: 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