Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2016-08-16
Date Acceptance
2016-07-05
Citation
Heart, 2016, 103, pp.55-62
ISSN
1468-201X
Publisher
BMJ Publishing Group
Start Page
55
End Page
62
Journal / Book Title
Heart
Volume
103
Copyright Statement
© 2016 The Author(s). This article has been accepted for publication in Heart following peer review and can also be viewed on the journal’s website at http://dx.doi.org/10.1136/heartjnl-2016-309706.
Sponsor
Commission of the European Communities
Royal Brompton & Harefield NHS Foundation Trust
Grant Number
288408
N/A
Subjects
Cardiovascular System & Hematology
1102 Cardiovascular Medicine And Haematology
Publication Status
Published