Abstract
Background: Failure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution’s ability to prevent death after a patient becomes complicated. Objectives: Develop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes. Research Design: Split-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results. Subjects: Older Medicare beneficiaries admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures: Thirty-day mortality and FTR rates, and in-hospital complication rates. Results: The 60% out-of-sample validation included 234,277 patients across 1142 hospitals that admitted at least 50 patients over 2.5 years. In total, 72.1% of patients were defined as Medically Complicated (complex on admission or subsequently developed a complication or died without a recorded complication) of whom 19.3% died. Spearman r between hospital risk-adjusted 30-day mortality and FTR was 0.89 (P<0.0001); Mortality versus Complication=−0.01 (P=0.6198); FTR versus Complication=−0.10 (P=0.0011). Major teaching hospitals displayed 19% lower odds of FTR versus non-teaching hospitals (odds ratio=0.81, P<0.0001), while hospitals as a group defined by teaching hospital status, comprehensive cardiac technology, and having good nursing mix and staffing, displayed a 33% lower odds of FTR (odds ratio=0.67, P<0.0001) versus hospitals without any of these characteristics. Conclusions: A modified FTR metric can be created that has many of the advantageous properties of surgical FTR and can aid in studying the quality of care of AMI admissions.
| Original language | English (US) |
|---|---|
| Journal | Medical Care |
| DOIs | |
| State | Accepted/In press - Mar 23 2018 |
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Keywords
- failure-to-rescue
- mortality
- quality of care
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
Cite this
Failure-to-Rescue After Acute Myocardial Infarction. / Silber, Jeffrey H.; Arriaga, Alexander F.; Niknam, Bijan A.; Hill, Alexander S.; Ross, Richard N.; Romano, Patrick S.
In: Medical Care, 23.03.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Failure-to-Rescue After Acute Myocardial Infarction
AU - Silber, Jeffrey H.
AU - Arriaga, Alexander F.
AU - Niknam, Bijan A.
AU - Hill, Alexander S.
AU - Ross, Richard N.
AU - Romano, Patrick S
PY - 2018/3/23
Y1 - 2018/3/23
N2 - Background: Failure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution’s ability to prevent death after a patient becomes complicated. Objectives: Develop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes. Research Design: Split-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results. Subjects: Older Medicare beneficiaries admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures: Thirty-day mortality and FTR rates, and in-hospital complication rates. Results: The 60% out-of-sample validation included 234,277 patients across 1142 hospitals that admitted at least 50 patients over 2.5 years. In total, 72.1% of patients were defined as Medically Complicated (complex on admission or subsequently developed a complication or died without a recorded complication) of whom 19.3% died. Spearman r between hospital risk-adjusted 30-day mortality and FTR was 0.89 (P<0.0001); Mortality versus Complication=−0.01 (P=0.6198); FTR versus Complication=−0.10 (P=0.0011). Major teaching hospitals displayed 19% lower odds of FTR versus non-teaching hospitals (odds ratio=0.81, P<0.0001), while hospitals as a group defined by teaching hospital status, comprehensive cardiac technology, and having good nursing mix and staffing, displayed a 33% lower odds of FTR (odds ratio=0.67, P<0.0001) versus hospitals without any of these characteristics. Conclusions: A modified FTR metric can be created that has many of the advantageous properties of surgical FTR and can aid in studying the quality of care of AMI admissions.
AB - Background: Failure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution’s ability to prevent death after a patient becomes complicated. Objectives: Develop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes. Research Design: Split-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results. Subjects: Older Medicare beneficiaries admitted to short-term acute-care hospitals for AMI between 2009 and 2011. Measures: Thirty-day mortality and FTR rates, and in-hospital complication rates. Results: The 60% out-of-sample validation included 234,277 patients across 1142 hospitals that admitted at least 50 patients over 2.5 years. In total, 72.1% of patients were defined as Medically Complicated (complex on admission or subsequently developed a complication or died without a recorded complication) of whom 19.3% died. Spearman r between hospital risk-adjusted 30-day mortality and FTR was 0.89 (P<0.0001); Mortality versus Complication=−0.01 (P=0.6198); FTR versus Complication=−0.10 (P=0.0011). Major teaching hospitals displayed 19% lower odds of FTR versus non-teaching hospitals (odds ratio=0.81, P<0.0001), while hospitals as a group defined by teaching hospital status, comprehensive cardiac technology, and having good nursing mix and staffing, displayed a 33% lower odds of FTR (odds ratio=0.67, P<0.0001) versus hospitals without any of these characteristics. Conclusions: A modified FTR metric can be created that has many of the advantageous properties of surgical FTR and can aid in studying the quality of care of AMI admissions.
KW - failure-to-rescue
KW - mortality
KW - quality of care
UR - http://www.scopus.com/inward/record.url?scp=85044452012&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044452012&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000000904
DO - 10.1097/MLR.0000000000000904
M3 - Article
C2 - 29578952
AN - SCOPUS:85044452012
JO - Medical Care
JF - Medical Care
SN - 0025-7079
ER -