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Quality/Patient Safety

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Hospitals with internal support for quality improvement are most likely to prescribe beta-blockers for heart attack patients

Beta-blockers are recommended for patients following a heart attack (acute myocardial infarction, AMI) in order to reduce their risk of death and subsequent cardiac problems. Hospitals most likely to prescribe beta-blockers for these patients are those that have greater support for quality improvement (QI) from administrators, nurses, and physicians; physician leaders who champion QI; and more available resources for QI, according to a new study. The study, which was supported in part by the Agency for Healthcare Research and Quality (HS10407), also found that standing orders to prescribe beta-blockers for heart attack patients was the only specific QI intervention that was associated with beta-blocker prescribing, but it had only borderline significance.

Unfortunately, nearly half of the U.S. hospitals studied did not employ standing orders for beta-blockers for heart attack patients, despite the potential effectiveness of this relatively simple intervention, notes AHRQ principal investigator Harlan M. Krumholz, M.D., of the Yale University School of Medicine. The researchers analyzed telephone survey responses from quality management directors at 234 hospitals. They linked these responses to data from the National Registry of Myocardial Infarction from October 1997 to September 1999 on 60,363 patients discharged with AMI from the hospitals.

Hospitals prescribed beta-blockers to a mean of 60 percent of AMI patients. However, prescribing ranged from a mean of 19 to 89 percent across hospitals. The top performing 20 percent of hospitals and middle 40 percent of hospitals were nearly twice as likely to have organizational support for QI efforts and nearly 10 times as likely to have physician advocates for QI as the low performing 20 percent of hospitals. These findings underscore the important role of individual physicians in organizational efforts to improve patient safety and quality of care.

See "Quality improvement efforts and hospital performance: Rates of beta-blocker prescription after acute myocardial infarction," by Elizabeth H. Bradley, Ph.D., Jeph Herrin, Ph.D., Jennifer A. Mattera, M.P.H., and others, in the March 2005 Medical Care 43(3), pp. 282-292.

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