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Patient Safety and Quality

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Americans can obtain quality heart care at hospitals that are not ranked in the top 50 by U.S. News & World Report

For information on hospital quality, many people rely on resources such as the magazine, U.S. News & World Report, which publishes annual ratings for hospitals based on their performance. Yet, when rated by how well they follow clinical guidelines for heart attack and heart failure, some top-ranked heart and heart surgery hospitals fall short in the quality of care they provide to heart patients. At the same time, many lesser known hospitals routinely provide cardiovascular care that is consistent with American College of Cardiology and American Heart Association clinical treatment guidelines, according to a new study.

This suggests that there are many other hospitals across the country, besides the "top" hospitals, where patients can receive high-quality heart care, conclude the study authors. They found that 41 hospitals selected in the magazine as top hospitals in heart care and heart surgery performed significantly better on 5 of 10 measures of a cardiovascular composite index than the other 733 hospitals included in the study, which did not make the top magazine's top 50 list.

Six measures of quality for care of a heart attack ranged from giving aspirin and/or a beta-blocker within 24 hours of hospital arrival to prescribing a beta-blocker at discharge. Four measures of quality for care of heart failure ranged from left ventricular function assessment upon hospital admission to prescribing of an angiotensin converting enzyme inhibitor and instructions about diet, weight, and worsening symptoms at discharge.

As a group, the top hospitals performed significantly better than their peers. Individually, however, only 23 of the top hospitals achieved statistically better-than-average performance compared with the hospital average, and 9 performed significantly worse; 167 hospitals in the study routinely implemented evidence-based heart care 90 percent or more of the time. The performance measures used in this study were evaluated with support from the Agency for Healthcare Research and Quality (HS13728).

More details are in "Performance of top-ranked heart care hospitals on evidence-based process measures," by Scott C. Williams, Psy.D., Richard G. Koss, M.A., David J. Morton, M.S., and Jerod M. Loeb, Ph.D., in the August 2006 Circulation 114, pp. 558-564.

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