ICU Use and Quality of Care for Patients With Myocardial Infarction and Heart Failure.
Quality of care for acute myocardial infarction (AMI) and heart failure (HF) varies across hospitals, but the factors driving variation are incompletely understood. We evaluated the relationship between a hospital's ICU or coronary care unit (CCU) admission rate and quality of care provided to patients with AMI or HF.



A retrospective cohort study of Medicare beneficiaries hospitalized in 2010 with AMI or HF was performed. Hospitals were grouped into quintiles according to their risk- and reliability-adjusted ICU admission rates for AMI or HF. We examined the rates that hospitals failed to deliver standard AMI or HF processes of care (process measure failure rates), 30-day mortality, 30-day readmissions, and Medicare spending after adjusting for patient and hospital characteristics.



Hospitals in the lowest quintile had ICU admission rates < 29% for AMI or < 8% for HF. Hospitals in the top quintile had rates > 61% for AMI or > 24% for HF. Hospitals in the highest quintile had higher process measure failure rates for some but not all process measures. Hospitals in the top quintile had greater 30-day mortality (14.8% vs 14.0% [P = .002] for AMI; 11.4% vs 10.6% [P < .001] for HF), but no differences in 30-day readmissions or Medicare spending were seen compared with hospitals in the lowest quintile.



Hospitals with the highest rates of ICU admission for patients with AMI or HF delivered lower quality of care and had higher 30-day mortality for these conditions. Hospitals with high ICU use may be targets to improve care delivery.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI. Electronic address: valleyt@umich.edu.
Thomas S
TS
Valley
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI.
Michael W
MW
Sjoding
Division of Cardiology, Department of Internal Medicine, University of Washington, Seattle, WA.
Zachary D
ZD
Goldberger
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI; Center for Health Outcomes and Policy, and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Colin R
CR
Cooke
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017048:Health Care Costs; D006333:Heart Failure / Q000628:therapy*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission; D011787:Quality of Health Care; D012189:Retrospective Studies; D014481:United States
cardiology; health-care utilization; heart failure; intensive care; myocardial infarction