Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales

Emdin, C. A. et al. (2016) Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. Heart, 103(1), pp. 55-62. (doi: 10.1136/heartjnl-2016-309706) (PMID:27530132)

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Objective: Investigation of variations in provider performance and its determinants may help inform strategies for improving patient outcomes. Methods: We used the National Heart Failure Audit comprising 68 772 patients with heart failure with reduced left ventricular ejection fraction (HFREF), admitted to 185 hospitals in England and Wales (2007–2013). We investigated hospital adherence to three recommended key performance measures (KPMs) for inhospital care (ACE inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) on discharge, β-blockers on discharge and referral to specialist follow-up) individually and as a composite performance score. Hierarchical regression models were used to investigate hospital-level variation. Results: Hospital-level variation in adherence to composite KPM ranged from 50% to 97% (median 79%), but after adjustments for patient characteristics and year of admission, only 8% (95% CI 7% to 10%) of this variation was attributable to variations in hospital features. Similarly, hospital prescription rates for ACE-I/ARB and β-blocker showed low adjusted hospital-attributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and β-blocker, respectively). Referral to specialist follow-up, however, showed larger variations (median 81%; range; 20%, 100%) with 26% of this being attributable to hospital-level differences (CI 22% to 31%). Conclusion: Only a small proportion of hospital variation in medication prescription after discharge was attributable to hospital-level features. This suggests that differences in hospital practices are not a major determinant of observed variations in prescription of investigated medications and outcomes. Future healthcare delivery efforts should consider evaluation and improvement of more ambitious KPMs.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Woodward, Professor Mark and Cleland, Professor John and McMurray, Professor John and Dargie, Professor Henry
Authors: Emdin, C. A., Conrad, N., Kiran, A., Salimi-Khorshidi, G., Woodward, M., Anderson, S. G., Mohseni, H., Dargie, H. J., Hardman, S. M.C., McDonagh, T., McMurray, J. J.V., Cleland, J. G.F., and Rahimi, K.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN (Online):1468-201X
Published Online:16 August 2016
Copyright Holders:Copyright © 2016 BMJ Publishing Group
First Published:First published in Heart 2016
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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