Clinical Investigation
Outcomes, Health Policy, and Managed Care
Do specialty cardiac hospitals have greater adherence to acute myocardial infarction and heart failure process measures? An empirical assessment using Medicare quality measures: Quality of care in cardiac specialty hospitals

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Background

Supporters of specialty hospitals claim these facilities provide better patient care; however, empirical data on quality of care in specialty hospitals are limited.

Methods

We used data reported to the Centers for Medicare and Medicaid Services (CMS) during 2005 to 2006 to compare the quality of care of specialty cardiac hospitals, competing general hospitals and a group of top-ranked cardiac hospitals as identified by the US News & World Report's list of “America's best cardiac hospitals” for acute myocardial infarction (AMI) and heart failure (HF). The main outcome was hospital compliance with CMS performance measures, expressed as the percentage of eligible patients with AMI or HF who received guidelines-based treatment.

Results

The mean compliance for all 179 hospitals was 95% for AMI measures, 91% for HF measures, and 94% for all cardiac care (AMI plus HF measures). Specialty hospitals' compliance with AMI and HF guidelines (95.2% and 91.3%) was similar to that of competing general hospitals (94.7% and 90.5%), whereas top-ranked cardiac hospitals compliance with both AMI and CHF measures (96.8% and 94.1%) was higher (P < .001). In supplemental analyses, we found that 40% of specialty hospitals were ranked in the top quartile of all 179 hospitals, as compared with 22.9% of top-ranked cardiac hospitals. Conversely, 25% specialty hospitals were in the lowest quartile, as compared to 7% of top-ranked cardiac hospitals.

Conclusions

Quality of care in specialty cardiac hospitals is similar to quality in competing general hospitals and top-ranked cardiac care hospitals, as measured by compliance with AMI and HF performance indicators. Quality of care appears to be slightly better for top-ranked cardiac hospitals as compared to general hospitals, but the overall performance of all hospitals is high.

Section snippets

Identification of specialty hospitals, competing general hospitals, and top-ranked cardiac hospitals

Specialty cardiac hospitals were identified using a method that has been described previously.1, 8 Briefly, we used 2003 Medicare Provider and Analysis Review (MedPAR) data to calculate the ratio of cardiac admissions to total admissions for each hospital. We then reviewed the 100 most specialized hospitals (ie, those with the highest ratios) and excluded from this list all hospitals providing general surgical, pediatric, or obstetric care resulting in the identification of 22 specialty cardiac

Results

During July 2005 to June 2006, 20 specialty hospitals, 111 competing general hospitals, and 48 top-ranked cardiac care hospitals that provided full revascularization services reported cardiac performance data to the HQA database. As expected, hospital characteristics differed significantly among these 3 groups (Table I). Specialty hospitals were less likely to be located in the northeast and more likely to be located in the west census region, as compared to top-ranked cardiac care hospitals.

Discussion

We found that the quality of cardiac care, as measured by adherence to HQA process measures for AMI and CHF in specialty cardiac hospitals, competing general hospitals, and a sample of leading national hospitals was uniformly very high. The adherence to process measures in specialty cardiac hospitals was similar to that of competing general hospitals; top-ranked cardiac hospitals, on the other hand, performed better than general hospitals. Top ranked and specialty hospitals appeared to have

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    The study is supported by a grants from the National Center for Research Resources, Bethesda, MD (K23 RR01997201), National Heart, Lung, and Blood Institute, Bethesda, MD, and the Robert Wood Johnson Physician Faculty Scholars Program, Stanford, CA (Dr Cram); from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs (HFP 04-149) (Dr Vaughan-Sarrazin); and from the Agency for Health care Research and Quality (1R01HS015571-01A1) (Dr Nallamothu). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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