New quality indicator for treatment of acute myocardial infarction
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New quality indicator for treatment of acute myocardial infarction. / Radosavac, Milos; Twerenbold, Raphael; Wagener, Max; Honegger, Ursina; Puelacher, Christian; Wildi, Karin; Reichlin, Tobias; Kreutzinger, Philipp; Stallone, Fabio; Hillinger, Petra; Jaeger, Cedric; Gimenez, Maria Rubini; Shrestha, Samyut; Heberer, Michael; Kuehne, Michael; Osswald, Stefan; Mueller, Christian.
In: Kardiovaskulare Medizin, Vol. 19, No. 7-8, 2016, p. 211-216.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - New quality indicator for treatment of acute myocardial infarction
AU - Radosavac, Milos
AU - Twerenbold, Raphael
AU - Wagener, Max
AU - Honegger, Ursina
AU - Puelacher, Christian
AU - Wildi, Karin
AU - Reichlin, Tobias
AU - Kreutzinger, Philipp
AU - Stallone, Fabio
AU - Hillinger, Petra
AU - Jaeger, Cedric
AU - Gimenez, Maria Rubini
AU - Shrestha, Samyut
AU - Heberer, Michael
AU - Kuehne, Michael
AU - Osswald, Stefan
AU - Mueller, Christian
PY - 2016
Y1 - 2016
N2 - Introduction: Crude mortality is commonly used as a quality indicator (QI) for the treatment of acute myocardial infarction (AMI), but has important limitations including its dependence on the local case-mix. We aimed to explore the feasibility of a novel approach using risk adjustment according to the Global Registry of Acute Coronary Events (GRACE). Methods: In 1471 consecutive patients admitted with AMI to a Swiss university hospital in 2012 and 2013, we quantified working hours needed by a trained healthcare professional to complement the available administrative dataset by detailed medical review of all available medical records to: 1) differentiate the subtypes of AMI in order to separate type 1 (including type 4) AMIs from type 2 and postoperative AMIs (GRACE is only validated for type 1 AMI); 2) add all medical variables required to calculate the GRACE score. Results: Detailed medical review identified 93 additional patients (6.7%) with AMI as the main diagnosis, who were missed in the administrative dataset. Complete data for the calculation of the GRACE score could be obtained for 1233 patients (93.8%). In both years, observed crude mortality was significantly lower than the expected in-hospital mortality using the GRACE model (2012 [n = 613]: crude mortality 6.0%, mean GRACE mortality 8.3% [95% CI 7.2-9.4%]; 2013 [n = 620]: crude mortality 5.8%, mean GRACE mortality 9.4% [95%CI 8.3-10.6%]). Overall, the number of working hours required to retrospectively complement the administrative dataset was 1150 hours (575 h per year). Conclusion: Assessment of risk-adjusted in-hospital mortality in AMI is feasible, provides important insights regarding treatment results while improving comparability between hospitals, but is very time-consuming if done retrospectively. Prospective documentation of the GRACE score within the electronic medical records would help to reduce the effort needed to obtain this novel QI. Further multicentre studies are warranted.
AB - Introduction: Crude mortality is commonly used as a quality indicator (QI) for the treatment of acute myocardial infarction (AMI), but has important limitations including its dependence on the local case-mix. We aimed to explore the feasibility of a novel approach using risk adjustment according to the Global Registry of Acute Coronary Events (GRACE). Methods: In 1471 consecutive patients admitted with AMI to a Swiss university hospital in 2012 and 2013, we quantified working hours needed by a trained healthcare professional to complement the available administrative dataset by detailed medical review of all available medical records to: 1) differentiate the subtypes of AMI in order to separate type 1 (including type 4) AMIs from type 2 and postoperative AMIs (GRACE is only validated for type 1 AMI); 2) add all medical variables required to calculate the GRACE score. Results: Detailed medical review identified 93 additional patients (6.7%) with AMI as the main diagnosis, who were missed in the administrative dataset. Complete data for the calculation of the GRACE score could be obtained for 1233 patients (93.8%). In both years, observed crude mortality was significantly lower than the expected in-hospital mortality using the GRACE model (2012 [n = 613]: crude mortality 6.0%, mean GRACE mortality 8.3% [95% CI 7.2-9.4%]; 2013 [n = 620]: crude mortality 5.8%, mean GRACE mortality 9.4% [95%CI 8.3-10.6%]). Overall, the number of working hours required to retrospectively complement the administrative dataset was 1150 hours (575 h per year). Conclusion: Assessment of risk-adjusted in-hospital mortality in AMI is feasible, provides important insights regarding treatment results while improving comparability between hospitals, but is very time-consuming if done retrospectively. Prospective documentation of the GRACE score within the electronic medical records would help to reduce the effort needed to obtain this novel QI. Further multicentre studies are warranted.
KW - Mortality
KW - Myocardial infarction
KW - Outcome
KW - Quality indicators
UR - http://www.scopus.com/inward/record.url?scp=85043614963&partnerID=8YFLogxK
M3 - SCORING: Journal article
AN - SCOPUS:85043614963
VL - 19
SP - 211
EP - 216
IS - 7-8
ER -
