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Canadian Journal of Cardiology

Hospital- and Patient-Level Analysis of Quality Indicators in Acute Coronary Syndrome Care: A Nationwide Database Study

Published:December 07, 2022DOI:https://doi.org/10.1016/j.cjca.2022.12.001

      Abstract

      Background

      This study aimed to clarify the variations in the quality of care provided to patients with acute coronary syndrome (ACS) and to investigate the association between quality of care and mortality at both hospital and patient levels with the use of a nationwide database.

      Methods

      Patients with ACS who underwent percutaneous coronary intervention (PCI) from April 2014 to March 2018 were included from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from administrative data and the association of the QIs with all-cause mortality were investigated.

      Results

      From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation was low (median proportion < 10%). At the hospital level, acute-phase composite QI score was associated with reduced risk-adjusted 30-day mortality (β = −0.92 [95% confidence interval −1.19 to −0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely associated with 30-day and 2-year mortalities, respectively (all P < 0.001).

      Conclusions

      Substantial variations in ACS care were observed in the current nationwide database. High adherence to the QI sets was associated with significant survival gains at both hospital and patient levels. Multilevel approach in QI assessment may be effective for improvement of survival in this population.

      Résumé

      Contexte

      L’étude présentée ici visait à mieux comprendre les variations dans la qualité des soins prodigués aux patients atteints d’un syndrome coronarien aigu (SCA) et à examiner, à l’aide d’une base de données nationale, l’association entre la qualité des soins et la mortalité à l’échelle des hôpitaux et des patients.

      Méthodologie

      Ont été inclus dans l’étude les patients atteints d’un SCA qui ont subi une intervention coronarienne percutanée (ICP) entre avril 2014 et mars 2018, selon la base de données japonaise sur les demandes de remboursement d’assurance maladie et des bilans de santé particuliers. Douze indicateurs de la qualité (IQ) tirés des données administratives de même que l’association entre ces IQ et la mortalité toutes causes confondues ont fait l’objet d’un examen.

      Résultats

      L’analyse des données de 216 436 patients traités dans 1215 hôpitaux a révélé que la réalisation d’une ICP le jour de l’admission, l’administration d’aspirine à l’arrivée, l’emploi d’un inhibiteur du récepteur P2Y12 et l’évaluation de la fonction ventriculaire gauche étaient des mesures fréquentes (proportion médiane > 90 %), tandis que le recours à la réadaptation cardiaque en consultation externe était rare (proportion médiane < 10 %). En ce qui concerne les hôpitaux, l’indice composite pour les IQ relatifs aux soins de phase aiguë a été associé à une réduction de la mortalité à 30 jours ajustée en fonction du risque (β = −0,92 [intervalle de confiance à 95 % : −1,19 à −0,65]; p < 0,001). Chez les patients, tous les IQ relatifs aux soins de phase aiguë ou subaiguë étaient inversement associés à la mortalité à 30 jours et à 2 ans (p < 0,001 dans les deux cas).

      Conclusions

      L’analyse des renseignements tirés d’une base de données nationale à jour révèle des variations importantes dans les soins prodigués aux patients atteints d’un SCA. Une forte observance des mesures correspondant aux ensembles d’IQ était associée à des gains importants sur le plan de la survie, tant à l’échelle des hôpitaux que des patients. Une approche multiniveau de l’évaluation des IQ pourrait donc permettre d’améliorer la survie dans cette population de patients.
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