Journal article
Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest
Circulation Cardiovascular quality and outcomes, Vol.13(9), pp.660-668
09/01/2020
DOI: 10.1161/CIRCOUTCOMES.120.006514
PMCID: PMC7539545
PMID: 32907387
Abstract
Background: A hospital's risk-standardized survival rate (RSSR) for in-hospital cardiac arrest has emerged as an important metric to benchmark and incentivize hospital resuscitation quality. We examined whether hospital performance on the RSSR metric was stable or dynamic year-over-year and whether low-performing hospitals were able to improve survival outcomes over time. Methods and Results: We used data from 84 089 adult patients with an in-hospital cardiac arrest from 166 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A 2-level hierarchical regression model was used to compute RSSRs during a baseline (2012-2013) and two follow-up periods (2014-2015 and 2016-2017). At baseline, hospitals were classified as top-, middle-, and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25%, respectively, on their RSSR metric during 2012 to 2013. We compared hospital performance on RSSR during follow-up between top, middle, and bottom-performing hospitals' at baseline. During 2012 to 2013, 42 hospitals were identified as top-performing (median RSSR, 31.7%), 82 as middle-performing (median RSSR, 24.6%), and 42 as bottom-performing (median RSSR, 18.7%). During both follow-up periods, >70% of top-performing hospitals ranked in the top 50%, a substantial proportion remained in the top 25% of RSSR during 2014 to 2015 (54.6%) and 2016 to 2017 (40.4%) follow-up periods. Likewise, nearly 75% of bottom-performing hospitals remained in the bottom 50% during both follow-up periods, with 50.0% in the bottom 25% of RSSR during 2014 to 2015 and 40.5% in the bottom 25% during 2016 to 2017. While percentile rankings were generally consistent over time at approximate to 45% of study hospitals, approximate to 1 in 5 (21.4%) bottom-performing hospitals showed large improvement in percentile rankings over time and a similar proportion (23.7%) of top-performing hospitals showed large decline in percentile rankings compared with baseline. Conclusions: Hospital performance on RSSR during baseline period was generally consistent over 4 years of follow-up. However, 1 in 5 bottom-performing hospitals had large improvement in survival over time. Identifying care and quality improvement innovations at these sites may provide opportunities to improve in-hospital cardiac arrest care at other hospitals.
Details
- Title: Subtitle
- Trajectory of Risk-Standardized Survival Rates for In-Hospital Cardiac Arrest
- Creators
- Abdul H. Qazi - University of IowaPaul S. Chan - University of Missouri–Kansas CityYunshu Zhou - Visual SciencesMary Vaughan-Sarrazin - Veterans Health AdministrationSaket Girotra - Veterans Health AdministrationAmerican Heart Association Get With the Guidelines—Resuscitation Investigators
- Resource Type
- Journal article
- Publication Details
- Circulation Cardiovascular quality and outcomes, Vol.13(9), pp.660-668
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1161/CIRCOUTCOMES.120.006514
- PMID
- 32907387
- PMCID
- PMC7539545
- ISSN
- 1941-7705
- eISSN
- 1941-7705
- Number of pages
- 9
- Grant note
- K08HL122527; R01HL123980 / VA Office of Rural Heath - National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA
- Language
- English
- Date published
- 09/01/2020
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359775502771
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