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dc.contributor.authorGranger, Christopher B.
dc.contributor.authorSteg, Phillippe Gabriel
dc.contributor.authorPeterson, Eric D.
dc.contributor.authorLópez-Sendón, José
dc.contributor.authorVan de Werf, Frans
dc.contributor.authorKline-Rogers, Eva M.
dc.contributor.authorAllegrone, Jeanna
dc.contributor.authorDabbous, Omar H.
dc.contributor.authorKlein, Werner
dc.contributor.authorFox, Keith A. A.
dc.contributor.authorEagle, Kim A.
dc.contributor.authorGRACE Investigators
dc.date2022-08-11T08:08:08.000
dc.date.accessioned2022-08-23T15:44:07Z
dc.date.available2022-08-23T15:44:07Z
dc.date.issued2005-08-09
dc.date.submitted2011-09-23
dc.identifier.citationAm J Med. 2005 Aug;118(8):858-65. <a href="http://dx.doi.org/10.1016/j.amjmed.2005.01.070">Link to article on publisher's site</a>
dc.identifier.issn0002-9343 (Linking)
dc.identifier.doi10.1016/j.amjmed.2005.01.070
dc.identifier.pmid16084178
dc.identifier.urihttp://hdl.handle.net/20.500.14038/27246
dc.description.abstractPURPOSE: To identify patient and health care factors which are related to the use of medical treatments that comprise quality measures and to assess the relation of these measures with mortality. METHODS: The study sample consisted of 20 140 patients with acute coronary syndromes from the international GRACE registry. Multivariable logistic regression modeling was used to determine predictors of quality performance. Quality indicators were use of aspirin and beta-blockers within 24 hours and at hospital discharge, use of angiotensin-converting enzyme (ACE) inhibitors at discharge, and in-hospital mortality. RESULTS: Use of medications in eligible patients at discharge ranged from 73% for ACE inhibitors to 93% for aspirin. High-risk features (eg, heart failure, older age) were related to failure to use aspirin and beta-blockers. Being at a teaching hospital and care by a cardiologist were associated with better use of aspirin and beta-blockers. Coronary artery bypass surgery was associated with failure to use ACE inhibitors and aspirin. When hospitals were divided into quartiles of quality performance, adjusted in-hospital mortality was 4.1% in the top versus 5.6% in the bottom quartile, representing a 27% (95% confidence interval: 11% to 42%) lower relative mortality. CONCLUSION: Identification of factors associated with failure to use proven treatments, including high-risk groups that would derive particular benefit from effective therapies, provides an opportunity to focus quality improvement interventions. The association of lower hospital mortality with better use of selected medical treatments supports their measurement to improve quality of care.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=16084178&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1016/j.amjmed.2005.01.070
dc.subjectAdrenergic beta-Antagonists
dc.subjectAge Factors
dc.subjectAged
dc.subjectAngina, Unstable
dc.subjectAngiotensin-Converting Enzyme Inhibitors
dc.subjectAspirin
dc.subjectAustralia
dc.subjectCardiology Service, Hospital
dc.subjectCoronary Artery Bypass
dc.subjectEurope
dc.subjectFemale
dc.subjectHospitals, Teaching
dc.subjectHumans
dc.subjectLogistic Models
dc.subjectMale
dc.subjectMyocardial Infarction
dc.subjectNorth America
dc.subjectPatient Admission
dc.subjectPatient Discharge
dc.subjectPlatelet Aggregation Inhibitors
dc.subject*Quality Assurance, Health Care
dc.subjectRegistries
dc.subjectTime Factors
dc.subjectVentricular Dysfunction, Left
dc.subjectHealth Services Research
dc.titleMedication performance measures and mortality following acute coronary syndromes
dc.typeArticle
dc.source.journaltitleThe American journal of medicine
dc.source.volume118
dc.source.issue8
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/cor_grace/65
dc.identifier.contextkey2254986
html.description.abstract<p>PURPOSE: To identify patient and health care factors which are related to the use of medical treatments that comprise quality measures and to assess the relation of these measures with mortality.</p> <p>METHODS: The study sample consisted of 20 140 patients with acute coronary syndromes from the international GRACE registry. Multivariable logistic regression modeling was used to determine predictors of quality performance. Quality indicators were use of aspirin and beta-blockers within 24 hours and at hospital discharge, use of angiotensin-converting enzyme (ACE) inhibitors at discharge, and in-hospital mortality.</p> <p>RESULTS: Use of medications in eligible patients at discharge ranged from 73% for ACE inhibitors to 93% for aspirin. High-risk features (eg, heart failure, older age) were related to failure to use aspirin and beta-blockers. Being at a teaching hospital and care by a cardiologist were associated with better use of aspirin and beta-blockers. Coronary artery bypass surgery was associated with failure to use ACE inhibitors and aspirin. When hospitals were divided into quartiles of quality performance, adjusted in-hospital mortality was 4.1% in the top versus 5.6% in the bottom quartile, representing a 27% (95% confidence interval: 11% to 42%) lower relative mortality.</p> <p>CONCLUSION: Identification of factors associated with failure to use proven treatments, including high-risk groups that would derive particular benefit from effective therapies, provides an opportunity to focus quality improvement interventions. The association of lower hospital mortality with better use of selected medical treatments supports their measurement to improve quality of care.</p>
dc.identifier.submissionpathcor_grace/65
dc.contributor.departmentCenter for Outcomes Research
dc.source.pages858-65


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