@article{22366,
  author = {Woodward Mark and McMurray J. and Dargie H. and Emdin C. and Anderson S. and Conrad Nathalie and Kiran A. and Salimi-Khorshidi G. and Mohseni H. and Hardman S. and McDonagh T. and Cleland J. and Rahimi K},
  title = {Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales},
  abstract = {<p>
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, beta-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 beta-blocker showed low adjusted hospital-attributable variations (7% CI 6% to 9% and 6% CI 5% to 8%, for ACE-I/ARB and beta-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.
</p>
},
  year = {2016},
  journal = {Heart},
  edition = {2016/08/18},
  isbn = {1468-201X (Electronic)<br/>1355-6037 (Linking)},
  note = {Emdin, Connor A<br/>Conrad, Nathalie<br/>Kiran, Amit<br/>Salimi-Khorshidi, Gholamreza<br/>Woodward, Mark<br/>Anderson, Simon G<br/>Mohseni, Hamid<br/>Dargie, Henry J<br/>Hardman, Suzanna M C<br/>McDonagh, Theresa<br/>McMurray, John J V<br/>Cleland, John G F<br/>Rahimi, Kazem<br/>Heart. 2016 Aug 16. pii: heartjnl-2016-309706. doi: 10.1136/heartjnl-2016-309706.},
  language = {Eng},
}