RT Journal Article
SR Electronic
T1 Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 55
OP 62
DO 10.1136/heartjnl-2016-309706
VO 103
IS 1
A1 Connor A Emdin
A1 Nathalie Conrad
A1 Amit Kiran
A1 Gholamreza Salimi-Khorshidi
A1 Mark Woodward
A1 Simon G Anderson
A1 Hamid Mohseni
A1 Henry J Dargie
A1 Suzanna M C Hardman
A1 Theresa McDonagh
A1 John J V McMurray
A1 John G F Cleland
A1 Kazem Rahimi
YR 2017
UL http://heart.bmj.com/content/103/1/55.abstract
AB Objective Investigation of variations in provider performance and its determinants may help inform strategies for improving patient outcomes.Methods We used the National Heart Failure Audit comprising 68 772 patients with heart failure with reduced left ventricular ejection fraction (HFREF), admitted to 185 hospitals in England and Wales (2007–2013). We investigated hospital adherence to three recommended key performance measures (KPMs) for inhospital care (ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on discharge, β-blockers on discharge and referral to specialist follow-up) individually and as a composite performance score. Hierarchical regression models were used to investigate hospital-level variation.Results Hospital-level variation in adherence to composite KPM ranged from 50% to 97% (median 79%), but after adjustments for patient characteristics and year of admission, only 8% (95% CI 7% to 10%) of this variation was attributable to variations in hospital features. Similarly, hospital prescription rates for ACE-I/ARB and β-blocker showed low adjusted hospital-attributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and β-blocker, respectively). Referral to specialist follow-up, however, showed larger variations (median 81%; range; 20%, 100%) with 26% of this being attributable to hospital-level differences (CI 22% to 31%).Conclusion Only a small proportion of hospital variation in medication prescription after discharge was attributable to hospital-level features. This suggests that differences in hospital practices are not a major determinant of observed variations in prescription of investigated medications and outcomes. Future healthcare delivery efforts should consider evaluation and improvement of more ambitious KPMs.