In evaluating the quality of care given to those hospitalized with heart failure, adherence to clinical guidelines may be a better measure of quality than the number of heart failure patients a hospital admits, according to new research in the American Heart Association's journal Circulation.
There's a feeling, the authors said, that hospitals performing more procedures, or treating more patients, are likely to have better outcomes. Instead, patients fare better at hospitals with established processes of care.
The financial implications are twofold. If hospitals without these established processes do deliver care that is subpar, that can potentially lead to an avoidable readmission, which can incur a penalty from the Centers for Medicare and Medicaid Services. Patient satisfaction scores also have an implication for reimbursement under federal rules, suggesting that stringent clinical guidelines may not only improve the quality of care, but of a hospital's balance sheets.
Not that high volume is necessarily an automatic detriment to care. In fact, the study -- which examined the medical records of 125,595 patients age 65 and older with heart failure -- found that hospitals with a higher volume of heart failure patients were more likely to adhere to "heart failure process measures," including appropriate testing, drug therapies and smoking cessation counseling.
Higher heart-failure-volume hospitals were also much more likely to place or prescribe upon discharge cardiac resynchronization therapy devices and implantable cardioverter defibrillators, which are medical devices that improve heart function by restoring a normal heart beat.
There was no difference in in-hospital mortality, readmissions to the hospital or mortality 30 days after discharge between large-volume and small-volume hospitals when the hospitals closely followed the guidelines outlined in the American Heart Association's Get With the Guidelines Heart Failure Program. There was, however, a slight decrease in hospital readmission and mortality 6 months after discharge between large-volume and small-volume hospitals when hospitals closely followed the guidelines.
The goal of the American Heart Association's program program is to improve in-hospital care through adherence to the latest scientific treatment guidelines.