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Despite overall national improvement in beta-blocker use after heart attack, the rate of improvement varies across hospitals

Use of beta-blockers following a heart attack (acute myocardial infarction, AMI) has been one area targeted to improve hospital quality of care since the mid-1990s. Rates of beta-blocker use after heart attack improved at some hospitals during the late 1990s but not at others, according to a study supported by the Agency for Healthcare Research and Quality (HS10407).

Researchers from Yale University School of Medicine, Yale-New Haven Hospital Center for Outcomes Research, and other institutions used data on 335,244 patients with AMI discharged from 682 hospitals from the National Registry of Myocardial Infarction and hospital characteristic data from the American Hospital Association Annual Survey of Hospitals. They examined associations between hospital characteristics and hospital-level rates of change in beta-blocker use during from 1996 to 1999.

The overall rate of beta-blocker use varied over time from about 46 percent of patients in April 1996 to more than 68 percent of patients in September 1999. On average, hospital rates of beta-blocker use for patients with AMI increased 5.9 percentage points from the first half of the study (April 1996 to February 1998) to the second half of the study (March 1998 to September 1999). The range in hospital-level changes in beta-blocker rates was substantial, from a decline of 50 percentage points to an increase of 35.7 percentage points.

Several hospital characteristics were correlated with improved use of beta-blockers. For instance, larger AMI volume was associated with greater improvement rates, especially for hospitals without residency programs. Hospitals in the Northeast had the greatest rates of improvement over time. Despite their significance, the associations between these hospital characteristics and improved beta-blocker use were modest, and much of the variation in use of beta-blockers across hospitals remains unexplained.

Details are in "Hospital-level performance improvement: Beta-blocker use after acute myocardial infarction," by Elizabeth H. Bradley, Ph.D., Jeph Herrin, Ph.D., Jennifer A. Mattera, M.P.H., and others, in the June 2004 Medical Care 42(6), pp. 591-599.

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