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

Connor A. Emdin, Nathalie Conrad, Amit Kiran, Gholamreza Salimi-Khorshidi, Mark Woodward, Simon G. Anderson, Hamid Mohseni, Henry J. Dargie, Suzanna M C Hardman, Theresa McDonagh, John J V McMurray, John G F Cleland, Kazem Rahimi

Research output: Contribution to journalArticle

Abstract

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, ß-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 ß-blocker showed low adjusted hospitalattributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and ß-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.

Original languageEnglish (US)
JournalHeart
DOIs
StateAccepted/In press - Aug 16 2016
Externally publishedYes

Fingerprint

Wales
England
Heart Failure
Angiotensin Receptor Antagonists
Prescriptions
Referral and Consultation
Angiotensin-Converting Enzyme Inhibitors
Stroke Volume
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Emdin, C. A., Conrad, N., Kiran, A., Salimi-Khorshidi, G., Woodward, M., Anderson, S. G., ... Rahimi, K. (Accepted/In press). Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. Heart. https://doi.org/10.1136/heartjnl-2016-309706

Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. / Emdin, Connor A.; Conrad, Nathalie; Kiran, Amit; Salimi-Khorshidi, Gholamreza; Woodward, Mark; Anderson, Simon G.; Mohseni, Hamid; Dargie, Henry J.; Hardman, Suzanna M C; McDonagh, Theresa; McMurray, John J V; Cleland, John G F; Rahimi, Kazem.

In: Heart, 16.08.2016.

Research output: Contribution to journalArticle

Emdin, CA, Conrad, N, Kiran, A, Salimi-Khorshidi, G, Woodward, M, Anderson, SG, Mohseni, H, Dargie, HJ, Hardman, SMC, McDonagh, T, McMurray, JJV, Cleland, JGF & Rahimi, K 2016, 'Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales', Heart. https://doi.org/10.1136/heartjnl-2016-309706
Emdin, Connor A. ; Conrad, Nathalie ; Kiran, Amit ; Salimi-Khorshidi, Gholamreza ; Woodward, Mark ; Anderson, Simon G. ; Mohseni, Hamid ; Dargie, Henry J. ; Hardman, Suzanna M C ; McDonagh, Theresa ; McMurray, John J V ; Cleland, John G F ; Rahimi, Kazem. / Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. In: Heart. 2016.
@article{2d5579fb2f8e45f19c9946f63a83c851,
title = "Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales",
abstract = "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, {\ss}-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 {\ss}-blocker showed low adjusted hospitalattributable variations (7{\%} CI 6{\%} to 9{\%} and 6{\%} CI 5{\%} to 8{\%}, for ACE-I/ARB and {\ss}-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.",
author = "Emdin, {Connor A.} and Nathalie Conrad and Amit Kiran and Gholamreza Salimi-Khorshidi and Mark Woodward and Anderson, {Simon G.} and Hamid Mohseni and Dargie, {Henry J.} and Hardman, {Suzanna M C} and Theresa McDonagh and McMurray, {John J V} and Cleland, {John G F} and Kazem Rahimi",
year = "2016",
month = "8",
day = "16",
doi = "10.1136/heartjnl-2016-309706",
language = "English (US)",
journal = "Heart",
issn = "1355-6037",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales

AU - Emdin, Connor A.

AU - Conrad, Nathalie

AU - Kiran, Amit

AU - Salimi-Khorshidi, Gholamreza

AU - Woodward, Mark

AU - Anderson, Simon G.

AU - Mohseni, Hamid

AU - Dargie, Henry J.

AU - Hardman, Suzanna M C

AU - McDonagh, Theresa

AU - McMurray, John J V

AU - Cleland, John G F

AU - Rahimi, Kazem

PY - 2016/8/16

Y1 - 2016/8/16

N2 - 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, ß-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 ß-blocker showed low adjusted hospitalattributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and ß-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.

AB - 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, ß-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 ß-blocker showed low adjusted hospitalattributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and ß-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.

UR - http://www.scopus.com/inward/record.url?scp=84983503802&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84983503802&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2016-309706

DO - 10.1136/heartjnl-2016-309706

M3 - Article

C2 - 27530132

AN - SCOPUS:84983503802

JO - Heart

JF - Heart

SN - 1355-6037

ER -