Association between a hospital's quality performance for in-hospital cardiac arrest and common medical conditions.
BACKGROUND
Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown whether this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions.


RESULTS
Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia from Hospital Compare for the same period. The relationship between a hospital's performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26 270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an interquartile range of 19.7% to 24.2%. There were no significant correlations between a hospital's outcomes for its cardiac arrest patients and its patients admitted for acute myocardial infarction (correlation, -0.12; P=0.16), heart failure (correlation, -0.05; P=0.57), or pneumonia (correlation, -0.15; P=0.10).


CONCLUSIONS
Hospitals that performed better on publicly reported outcomes for 3 common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality.
Division of General Medicine, Department of Internal Medicine, and Institute for Healthcare Policy and Innovation.
Lena M
LM
Chen
Brahmajee K
BK
Nallamothu
Harlan M
HM
Krumholz
John A
JA
Spertus
Fengming
F
Tang
Paul S
PS
Chan
D000368:Aged; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000401:mortality; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology* / Q000401:mortality; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
heart failure; myocardial infarction; resuscitation