Search

All patients deserve high quality hospital care and the best possible outcome Research describing variation in hospital treatment and outcomes has improved care for patients with acute myocardial infarction. Studies, particularly from the United States, have shown significant differences in hospitals’ use of evidence based tests and treatments for acute myocardial infarction including aspirin, β blockers, and angiotensin converting enzyme inhibitors.1 In response, major US organizations developed a set of core process measures for treatments considered to be standard of care.2 Hospitals’ performance on these measures were publicly reported and used to guide reimbursement.3 Subsequently, research identified significant variation in hospitals’ outcomes for acute myocardial infarction, including rates of 30 day readmission and mortality.4 The federal government has used hospitals’ performance on these metrics to exact financial penalties on institutions with worse than expected 30 day outcomes.5 It is with this focus on quality of healthcare that Chung and colleagues in the linked paper (doi:10.1136/bmj.h3913) describe variation in guideline recommended treatments and outcomes for patients admitted with acute myocardial infarction in the United Kingdom and Sweden.6 The authors examined nationwide registry data from all hospitals providing care for acute myocardial infarction in both countries between 2004 and 2010. They found that variation in …

Hospital acquired conditions must be reduced throughout the week, not just at weekends In the United States, efforts to improve patient safety have focused, in part, on reducing hospital acquired conditions, or HACs. Hospital acquired conditions include healthcare associated infections, iatrogenic complications, and other adverse events occurring during treatment for another condition. Historically, the additional costs incurred by these adverse events led to greater payments by the government.1 To encourage a reduction in these potentially preventable conditions, the US Centers for Medicare and Medicaid Services (CMS) in 2008 decided not to pay for the higher costs of care resulting from 14 specific hospital acquired conditions.2 Starting this year, the CMS’s HAC Reduction Program will levy considerable financial penalties on hospitals scoring poorly on a composite measure of performance regarding hospital acquired conditions, which is derived from a review of administrative claims and medical record data.3 4 In a linked paper, Attenello and colleagues (doi:10.1136/bmj.h1460) determined whether weekend admission is associated with a greater likelihood of developing these adverse events,5 as weekend admission has been associated with worse outcomes for a large number of life threatening conditions, such as myocardial infarction,6 pulmonary embolism,7 and intracerebral haemorrhage.8 …

Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions. Design Retrospective cohort study. Setting Medicare beneficiaries in the United States. Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measures Readmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services’ condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers. Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P