Clinical InvestigationOutcomes, Health Policy, and Managed CareDo 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
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.