The contribution of the composite of clinical process indicators as a measure of hospital performance in the management of acute coronary syndromes-insights from the CONCORDANCE registry

Aliprandi-Costa, B; Sockler, J; Kritharides, L; Morgan, L; Snell, LC; Gullick, J; Brieger, D; Ranasinghe, I

The contribution of the composite of clinical process indicators as a measure of hospital performance in the management of acute coronary syndromes-insights from the CONCORDANCE registry

Aliprandi-Costa, B Sockler, J Kritharides, L Morgan, L Snell, LC

Gullick, J Brieger, D Ranasinghe, I

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Publication Type:: Journal Article
Citation:: European Heart Journal - Quality of Care and Clinical Outcomes, 2017, 3 (1), pp. 37 - 46
Issue Date:: 2017-01-01

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Field	Value	Language
dc.contributor.author	Aliprandi-Costa, B	en_US
dc.contributor.author	Sockler, J	en_US
dc.contributor.author	Kritharides, L	en_US
dc.contributor.author	Morgan, L	en_US
dc.contributor.author	Snell, LC https://orcid.org/0000-0001-5392-2656	en_US
dc.contributor.author	Gullick, J	en_US
dc.contributor.author	Brieger, D	en_US
dc.contributor.author	Ranasinghe, I	en_US
dc.date.issued	2017-01-01	en_US
dc.identifier.citation	European Heart Journal - Quality of Care and Clinical Outcomes, 2017, 3 (1), pp. 37 - 46	en_US
dc.identifier.issn	2058-5225	en_US
dc.identifier.uri	http://hdl.handle.net/10453/44017
dc.description.abstract	© The Author 2016. Aims Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in the delivery of care between hospitals persists. A composite measure of adherence with evidence-based clinical-process indicators (CPIs) could better inform hospital performance reporting and clinical outcomes in the management of ACS. Methods Data on 7444 ACS patients from 39 Australian hospitals were used to derive a hospital-specific composite quality score by calculating mean adherence to 14 evidence-based CPIs. Using the generalized estimating equation to account for clustering of patients within hospitals and the GRACE risk score to adjust for differences in presenting risk, we evaluated associations between the hospital-specific composite quality score, in-hospital major adverse events, in-hospital mortality and mortality and readmission for ACS at 6 months. Results Hospitals had a mean adherence of 68.3% (SD 21.7) with the composite quality score. There was significant variation between hospital adherence tertile 1 (79%) and tertile 3 (56%), P, 0.0001. With risk adjustment, there was an association between hospitals with a higher composite quality score and reduced in-hospital adverse events (OR: 0.85, CI: 0.71 - 0.99) and survival at hospital discharge (OR: 0.47; 95% CI: 0.28 - 0.77). There was trending improvement in survival at 6 months (OR 0.48; CI: 0.20 - 1.16) and fewer readmissions to hospital for ACS at 6 months (OR 0.79; CI 0.60 - 1.05). Conclusion The association between the quality composite score and reduced in-hospital events and survival at hospital discharge supports the utility of reporting CPIs in routine hospital performance reporting on the management of ACS.	en_US
dc.relation.ispartof	European Heart Journal - Quality of Care and Clinical Outcomes	en_US
dc.relation.isbasedon	10.1093/ehjqcco/qcw023	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Registries	en_US
dc.subject.mesh	Hospital Mortality	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Risk Factors	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Middle Aged	en_US
dc.subject.mesh	Hospitals	en_US
dc.subject.mesh	Disease Management	en_US
dc.subject.mesh	Guideline Adherence	en_US
dc.subject.mesh	Outcome and Process Assessment (Health Care)	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Acute Coronary Syndrome	en_US
dc.subject.mesh	Outcome and Process Assessment, Health Care	en_US
dc.title	The contribution of the composite of clinical process indicators as a measure of hospital performance in the management of acute coronary syndromes-insights from the CONCORDANCE registry	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	3	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	3	en_US

Abstract:

© The Author 2016. Aims Acute coronary syndrome (ACS) is a costly condition for health service provision yet variation in the delivery of care between hospitals persists. A composite measure of adherence with evidence-based clinical-process indicators (CPIs) could better inform hospital performance reporting and clinical outcomes in the management of ACS. Methods Data on 7444 ACS patients from 39 Australian hospitals were used to derive a hospital-specific composite quality score by calculating mean adherence to 14 evidence-based CPIs. Using the generalized estimating equation to account for clustering of patients within hospitals and the GRACE risk score to adjust for differences in presenting risk, we evaluated associations between the hospital-specific composite quality score, in-hospital major adverse events, in-hospital mortality and mortality and readmission for ACS at 6 months. Results Hospitals had a mean adherence of 68.3% (SD 21.7) with the composite quality score. There was significant variation between hospital adherence tertile 1 (79%) and tertile 3 (56%), P, 0.0001. With risk adjustment, there was an association between hospitals with a higher composite quality score and reduced in-hospital adverse events (OR: 0.85, CI: 0.71 - 0.99) and survival at hospital discharge (OR: 0.47; 95% CI: 0.28 - 0.77). There was trending improvement in survival at 6 months (OR 0.48; CI: 0.20 - 1.16) and fewer readmissions to hospital for ACS at 6 months (OR 0.79; CI 0.60 - 1.05). Conclusion The association between the quality composite score and reduced in-hospital events and survival at hospital discharge supports the utility of reporting CPIs in routine hospital performance reporting on the management of ACS.

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http://hdl.handle.net/10453/44017