Hospital Volume Falls Short as Metric of Quality of Heart Failure Care


By Megan Brooks

NEW YORK (Reuters Health) - For assessing the quality of inpatient heart failure (HF) care, hospitals’ adherence to clinical guidelines may be a more important factor than the volume of patients they treat, new research suggests.

“There is a feeling that hospitals that perform more procedures or treat more patients for a certain condition are likely to have better outcomes. But what we have found in this study, and others we have conducted, is that patients at hospitals with established processes of care fare better,” lead study author Dr. Dharam Kumbhani of UT Southwestern Medical Center in Dallas said in a news release.

The researchers reviewed the medical records of 125,595 patients age 65 or older who were treated for HF at 342 hospitals participating in the American Heart Association Get With the Guidelines-Heart Failure program from 2005 through 2014. They assessed the association among hospital volume, processes of care, and outcomes out to six months.

Compared with lower-volume hospitals, higher-volume hospitals were more likely to follow HF processes of care, including measuring left-ventricular function, prescribing anticoagulation for patients with atrial fibrillation, prescribing a beta-blocker at discharge, placing or prescribing an implantable cardioverter-defibrillator, and providing smoking-cessation counseling.

Risk-adjusted outcomes, including in-hospital mortality, were similar in higher- and lower-volume hospitals out to 30 days when the hospitals adhered to recommended processes of care, but higher-volume hospitals had slightly lower mortality and readmission rates at six months.

The use of volume as a surrogate for quality has “gained traction” for acute conditions such as HF and acute MI, the authors note in their paper. But going to a high-volume hospital for HF care “doesn’t guarantee that you’ll have the best outcomes,” Dr. Kumbhani added in the news release. “Identifying the hospitals that provide the best care is more complicated than that, and patients and health policy makers should recognize that smaller-volume hospitals can deliver outstanding care.”

“From a policy standpoint, we believe that hospital profiling should focus on participation in systems of care, adherence to process metrics, and risk-standardized outcomes rather than on hospital volume itself,” Dr. Kumbhani told Reuters Health by email.

The study had no commercial funding. Dr. Kumbhani is a consultant for Somahlution, a biotech company. Other researchers in the study are consultants for various medical and pharmaceutical companies.


Circulation 2018.

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