Reduction in Acute Myocardial Infarction Mortality in the United States Risk-Standardized Mortality Rates From 1995-2006

被引:214
作者
Krumholz, Harlan M. [1 ,2 ,3 ,5 ]
Wang, Yun [1 ,5 ]
Chen, Jersey [1 ]
Drye, Elizabeth E. [1 ]
Spertus, John A. [6 ,7 ]
Ross, Joseph S. [8 ,9 ,10 ]
Curtis, Jeptha P. [1 ]
Nallamothu, Brahmajee K. [11 ,12 ]
Lichtman, Judith H. [4 ]
Havranek, Edward P. [13 ,14 ]
Masoudi, Frederick A. [13 ,14 ]
Radford, Martha J. [15 ]
Han, Lein F. [16 ,17 ]
Rapp, Michael T. [16 ,17 ]
Straube, Barry M. [16 ,17 ]
Normand, Sharon-Lise T. [18 ,19 ]
机构
[1] Yale Univ, Sch Med, Sect Cardiovasc Med, New Haven, CT 06510 USA
[2] Yale Univ, Sch Med, Robert Wood Johnson Clin Scholars Program, New Haven, CT 06510 USA
[3] Yale Univ, Sch Med, Sect Hlth Policy & Adm, Sch Publ Hlth, New Haven, CT 06510 USA
[4] Yale Univ, Sch Med, Sect Chron Dis Epidemiol, Sch Publ Hlth, New Haven, CT 06510 USA
[5] Yale New Haven Med Ctr, Ctr Outcomes Res & Evaluat, New Haven, CT 06504 USA
[6] Univ Missouri Kansas City, Sch Med, Kansas City, MO USA
[7] Mid Amer Heart Inst, Kansas City, MO USA
[8] Mt Sinai Sch Med, Dept Geriatr & Adult Dev, New York, NY USA
[9] James J Peters VA Med Ctr, Ctr Geriatr Res Educ & Clin, Bronx, NY USA
[10] Hlth Serv Res Enhancement Award Program, Bronx, NY USA
[11] Univ Michigan, Sch Med, Hlth Serv Res & Dev Ctr Excellence, Ann Arbor VA Med Ctr, Ann Arbor, MI USA
[12] Univ Michigan, Sch Med, Div Cardiovasc Dis, Dept Internal Med, Ann Arbor, MI USA
[13] Univ Colorado, Hlth Sci Ctr, Denver, CO USA
[14] Denver Hlth Med Ctr, Denver, CO USA
[15] NYU, Sch Med, New York, NY USA
[16] Ctr Medicare, Baltimore, MD USA
[17] Ctr Medicaid Serv, Baltimore, MD USA
[18] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[19] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2009年 / 302卷 / 07期
关键词
QUALITY-OF-CARE; NATIONAL REGISTRY; HOSPITAL MORTALITY; TRENDS; MEDICARE; IMPROVEMENT; ELEVATION; COMMUNITY; OUTCOMES; PROGRAM;
D O I
10.1001/jama.2009.1178
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. Objective To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Design, Setting, and Patients Observational study using administrative data and a validated risk model to evaluate 3 195 672 discharges in 2 755 370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Main Outcome Measure Hospital-specific 30-day all-cause RSMR. Results At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Conclusion Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation. JAMA. 2009;302(7):767-773
引用
收藏
页码:767 / 773
页数:7
相关论文
共 21 条
  • [1] Shattuck lecture - Cardiovascular medicine at the turn of the millennium: Triumphs, concerns, and opportunities
    Braunwald, E
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (19) : 1360 - 1369
  • [2] A WILCOXON-TYPE TEST FOR TREND
    CUZICK, J
    [J]. STATISTICS IN MEDICINE, 1985, 4 (01) : 87 - 90
  • [3] Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006
    Fox, Keith A. A.
    Steg, Philippe Gabriel
    Eagle, Kim A.
    Goodman, Shaun G.
    Anderson, Frederick A., Jr.
    Granger, Christopher B.
    Flather, Marcus D.
    Budaj, Andrzej
    Quill, Ann
    Gore, Joel M.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 297 (17): : 1892 - 1900
  • [4] Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006
    Gibson, C. Michael
    Pride, Yuri B.
    Frederick, Paul D.
    Pollack, Charles V., Jr.
    Canto, John G.
    Tiefenbrunn, Alan J.
    Weaver, W. Douglas
    Lambrew, Costas T.
    French, William J.
    Peterson, Eric D.
    Rogers, William J.
    [J]. AMERICAN HEART JOURNAL, 2008, 156 (06) : 1035 - 1044
  • [5] A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case-fatality rates of acute myocardial infarction: A community-wide perspective
    Goldberg, RJ
    Yarzebski, J
    Lessard, D
    Gore, JM
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1999, 33 (06) : 1533 - 1539
  • [6] Gunnar R M, 1990, Circulation, V82, P664
  • [7] THE HEALTH-CARE QUALITY IMPROVEMENT INITIATIVE - A NEW APPROACH TO QUALITY ASSURANCE IN MEDICARE
    JENCKS, SF
    WILENSKY, GR
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 268 (07): : 900 - 903
  • [8] Care in US hospitals - The Hospital Quality Alliance Program.
    Jha, AK
    Li, ZH
    Orav, EJ
    Epstein, AM
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (03) : 265 - 274
  • [9] Accuracy of Medicare claims-based diagnosis of acute myocardial infarction: Estimating positive predictive value on the basis of review of hospital records
    Kiyota, Y
    Schneeweiss, S
    Glynn, RJ
    Cannuscio, CC
    Avorn, J
    Solomon, DH
    [J]. AMERICAN HEART JOURNAL, 2004, 148 (01) : 99 - 104
  • [10] An administrative claims model suitable for profiling hospital performance based on 30-day mortality rates among patients with an acute myocardial infarction
    Krumholz, HM
    Wang, Y
    Mattera, JA
    Wang, YF
    Han, LF
    Ingber, MJ
    Roman, S
    Normand, SLT
    [J]. CIRCULATION, 2006, 113 (13) : 1683 - 1692