nach oben

Erschienen in:

01.09.2008 | Original Article

Quality of Care for Decompensated Heart Failure: Comparable Performance between Academic Hospitalists and Non-hospitalists

verfasst von: Eduard E. Vasilevskis, MD, David Meltzer, MD PhD, Jeffrey Schnipper, MD MPH, Peter Kaboli, MD, Tosha Wetterneck, MD, David Gonzales, MD, Vineet Arora, MD, James Zhang, PhD, Andrew D. Auerbach, MD MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 9/2008

Einloggen, um Zugang zu erhalten

Abstract

Background

Hospitalists improve efficiency, but little information exists regarding whether they impact quality of care.

Objective

To determine hospitalists’ effect on the quality of acute congestive heart failure care.

Design and Participants

Using data from the Multicenter Hospitalist Study, we retrospectively evaluated quality of care in patients admitted with congestive heart failure who were assigned to hospitalists (n = 120) or non-hospitalists (n = 252) among six academic hospitals.

Measurements

Quality measures included the percentage of patients who had ejection fraction (EF) measurement, received appropriate medications [i.e., angiotensin-converting enzyme inhibitor (ACE-I) or beta-blockers] at discharge, measures of care coordination (e.g., follow-up within 30 days), testing for cardiac ischemia (e.g., cardiac catheterization), as well as hospital length of stay, cost, and combined 30-day readmissions and mortality.

Results

Compared to non-hospitalist physicians, hospitalists’ patients had similar rates of EF measurement (85.3% vs. 87.5%; P = 0.57), ACE-I (91.5% vs. 88.0%; P = 0.52), or beta-blocker (46.9% vs. 42.1%; P = 0.57) prescriptions. Multivariable adjustment did not change these findings. Hospitalists’ patients had higher odds of 30-day follow-up (adjusted OR = 1.83, 95% CI, 1.44 – 2.93). There were no significant differences between the groups’ frequency of cardiac testing, length of stay, costs, or risk for readmission or death by 30-days.

Conclusion

Academic hospitalists and non-hospitalists provide similar quality of care for heart failure patients, although hospitalists are paying more attention to longitudinal care. Future efforts to improve quality of care in decompensated heart failure may require attention towards system-level factors.

Nur mit Berechtigung zugänglich

Miniño AM, Heron MP, Smith BL. Deaths: Preliminary Data for 2004. National vital statistics reports; vol 54 no 19. Hyattsville, MD: National Center for Health Statistics; 2006.

Krumholz HM, Parent EM, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104.PubMedCrossRef

Joint Commission on Accreditation of Healthcare Organizations. Ongoing Activities: 2000 to 2004 Standardization of Metrics. Available at: http://www.jointcommission.org/NR/rdonlyres/551576B9-4E5C-4C0D-ACA5-6FC5D788A5D4/0/OngoingActivities.pdf. Accessed April 14, 2008

Centers for Medicare and Medicaid Services. Hospital Quality Initiative Overview, December 2005. Available at: http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalOverview200512.pdf. Accessed April 14, 2008.

Williams SC, Schmaltz SP, Morton DJ, Koss RG, Loeb JM. Quality of care in U.S. hospitals as reflected by standardized measures, 2002–2004. N Engl J Med. 2005;353:255–64.PubMedCrossRef

Fonarow GC, Yancy CW, Heywood JT. Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE Registry. Arch Intern Med. 2005;165:1469–77.PubMedCrossRef

Go AS, Rao RK, Dauterman KW, Massie BM. A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the United States. Am J Med. 2000;108:216–26.PubMedCrossRef

Jong P, Gong Y, Liu PP, Austin PC, Lee DS, Tu JV. Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists. Circulation. 2003;108:184–91.PubMedCrossRef

Ko DT, Tu JV, Masoudi FA, et al. Quality of care and outcomes of older patients with heart failure hospitalized in the United States and Canada. Arch Intern Med. 2005;165:2486–92.PubMedCrossRef

10.

Goldman L. The impact of hospitalists on medical education and the academic health system. Ann Intern Med. 1999;130:364–7.PubMed

11.

Wachter R. Hospitals and hospitalists can reach across the “quality chasm” by restructuring inpatient care. Cost Qual. 2001:21–2.

12.

Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287:487–94.PubMedCrossRef

13.

Lindenauer PK, Rothberg MB, Pekow PS, Kenwood C, Benjamin EM, Auerbach AD. Outcomes of Care by Hospitalists, General Internists, and Family Physicians. N Engl J Med. 2007;357:2589–600.PubMedCrossRef

14.

Lindenauer PK, Chehabeddine R, Pekow P, Fitzgerald J, Benjamin EM. Quality of care for patients hospitalized with heart failure: assessing the impact of hospitalists. Arch Intern Med. 2002;162:1251–6.PubMedCrossRef

15.

Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Validation of a telephone version of the mini-mental state examination. J Am Geriatr Soc. 1992;40:697–702.PubMed

16.

Auerbach AD, Hamel MB, Davis RB, et al. Resource use and survival of patients hospitalized with congestive heart failure: differences in care by specialty of the attending physician. Ann Intern Med. 2000;132:191–200.PubMed

17.

Meltzer D, Manning WG, Morrison J, et al. Effects of physician experience on costs and outcomes on an academic general medicine service: results of a trial of hospitalists. Ann Intern Med. 2002;137:866–74.PubMed

18.

National Death Index user’s manual. No. 03-0078. Hyattsville, Md.: National Center for Health Statistics, October 2000.

19.

Wachter RM, Goldman L. The emerging role of “hospitalists” in the American health care system. N Engl J Med. 1996;335:514–7.PubMedCrossRef

20.

Lee DS, Tran C, Flintoft V, Grant FC, Liu PP, Tu JV. CCORT/CCS quality indicators for congestive heart failure care. Can J Card. 2003;19:357–64.

21.

Heart Failure Society Of A. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006;12:e1–2.

22.

Ahmed A, Allman RM, Kiefe CI, et al. Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care. Am Heart J. 2003;145:1086–93.PubMedCrossRef

23.

Polanczyk CA, Newton C, Dec GW, Di Salvo TG. Quality of care and hospital readmission in congestive heart failure: an explicit review process. J Card Fail. 2001;7:289–98.PubMedCrossRef

24.

Ritter PL, Stewart AL, Kaymaz H, Sobel DS, Block DA, Lorig KR. Self-reports of health care utilization compared to provider records. J Clin Epidemiol. 2001;54:136–41.PubMedCrossRef

25.

Schafer JL. Multiple imputation: a primer. Statistical Methods in Medical Research. 1999;8:3–15.PubMedCrossRef

26.

Auerbach AD, Wachter RM, Katz P, Showstack J, Baron RB, Goldman L. Implementation of a voluntary hospitalist service at a community teaching hospital: improved clinical efficiency and patient outcomes. Ann Intern Med. 2002;137:859–65.PubMed

27.

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297:831–41.PubMedCrossRef

28.

Rifkin WD, Conner D, Silver A, Eichorn A. Comparison of processes and outcomes of pneumonia care between hospitalists and community-based primary care physicians. Mayo Clin Proc. 2002;77:1053–8.PubMedCrossRef

29.

Shekelle PG, Ortiz E, Rhodes S, et al. Validity of the agency for healthcare research and quality clinical practice guidelines: how quickly do guidelines become outdated? JAMA. 2001;286:1461–7.PubMedCrossRef

30.

Fonarow GC. The role of in-hospital initiation of cardioprotective therapies to improve treatment rates and clinical outcomes. Rev Cardiovasc Med. 2002;3Suppl 3S2–10.PubMed

Titel: Quality of Care for Decompensated Heart Failure: Comparable Performance between Academic Hospitalists and Non-hospitalists
verfasst von: Eduard E. Vasilevskis, MD
David Meltzer, MD PhD
Jeffrey Schnipper, MD MPH
Peter Kaboli, MD
Tosha Wetterneck, MD
David Gonzales, MD
Vineet Arora, MD
James Zhang, PhD
Andrew D. Auerbach, MD MPH
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 9/2008
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0680-3

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Objective

Design and Participants

Measurements

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2008

The Specialist–Generalist Income Gap: Can We Narrow It?

A Profile of Concurrent Alcohol and Alcohol-Interactive Prescription Drug Use in the US Population

EDUC’AVK: Reduction of Oral Anticoagulant-related Adverse Events After Patient Education: A Prospective Multicenter Open Randomized Study

Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?

Preferences for Human Papillomavirus Testing with Routine Cervical Cancer Screening in Diverse Older Women

Classifying and Predicting Errors of Inpatient Medication Reconciliation