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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 …

Introduction During the past decade, the volume of percutaneous coronary intervention (PCI) in China has risen by more than 20-fold. Yet little is known about patterns of care and outcomes across hospitals, regions and time during this period of rising cardiovascular disease and dynamic change in the Chinese healthcare system. Methods and analysis Using the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) research network, the Retrospective Study of Coronary Catheterisation and Percutaneous Coronary Intervention (China PEACE-Retrospective CathPCI Study) will examine a nationally representative sample of 11 900 patients who underwent coronary catheterisation or PCI at 55 Chinese hospitals during 2001, 2006 and 2011. We selected patients and study sites using a two-stage cluster sampling design with simple random sampling stratified within economical-geographical strata. A central coordinating centre will monitor data quality at the stages of case ascertainment, medical record abstraction and data management. We will examine patient characteristics, diagnostic testing patterns, procedural treatments and in-hospital outcomes, including death, complications of treatment and costs of hospitalisation. We will additionally characterise variation in treatments and outcomes by patient characteristics, hospital, region and study year. Ethics and dissemination The China PEACE collaboration is designed to translate research into improved care for patients. The study protocol was approved by the central ethics committee at the China National Center for Cardiovascular Diseases (NCCD) and collaborating hospitals. Findings will be shared with participating hospitals, policymakers and the academic community to promote quality monitoring, quality improvement and the efficient allocation and use of coronary catheterisation and PCI in China. Registration details http://www.clinicaltrials.gov (NCT01624896).

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