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Achievement of Guideline-Concordant Care and In-Hospital Outcomes in Patients With Coronary Artery Disease in Teaching and Nonteaching Hospitals : Results From the Get With The Guidelines −Coronary Artery Disease Program Lori M. Tam, Gregg C. Fonarow, Deepak L. Bhatt, Maria V. Grau-Sepulveda, Adrian F. Hernandez, Eric D. Peterson, Lee H. Schwamm and Robert P. Giugliano Circ Cardiovasc Qual Outcomes 2013;6;58-65; originally published online December 11, 2012; DOI: 10.1161/CIRCOUTCOMES.112.965525
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Achievement of Guideline-Concordant Care and In-Hospital Outcomes in Patients With Coronary Artery Disease in Teaching and Nonteaching Hospitals
Results From the Get With The Guidelines–Coronary Artery Disease Program
Lori M. Tam, MD; Gregg C. Fonarow, MD; Deepak L. Bhatt, MD, MPH; Maria V. Grau-Sepulveda, MD, MPH; Adrian F. Hernandez, MD, MPH; Eric D. Peterson, MD, MPH; Lee H. Schwamm, MD; Robert P. Giugliano, MD, SM; on behalf of the GWTG Steering Committee and Investigators
Background—Secondary prevention therapies improve longitudinal outcomes in patients with coronary artery disease. Previous studies showed that teaching hospitals (THs) more consistently use evidence-based secondary prevention therapies than non-THs (NTHs). It is unclear whether these differences persist after initiation of a national quality improvement system. Methods and Results—We analyzed 270 902 patients across 361 hospitals in the Get With The Guidelines–Coronary Artery Disease program from June 2000 to September 2009. The primary outcome was guideline-concordant care, defined as compliance with all Get With The Guidelines–Coronary Artery Disease quality measures: (1) aspirin within 24 hours, (2) aspirin at discharge, (3) angiotensin-converting enzyme inhibitor/angiotensin receptor blockers for systolic dysfunction, (4) β-blockers at discharge, (5) lipid therapy if low-density lipoprotein >100 mg/dL, and (6) smoking cessation. We used multivariate modeling to compare the relationship between TH and NTH status on quality measures, in-hospital mortality, and length of stay. Guideline-concordant care was higher at THs (78.4% versus 73.3%; P4 days (adjusted OR, 0.74; CI, 0.58–0.94; Figure 4) from 2000 to 2009, although the LOS decreased in both TH and NTH over calendar time (adjusted OR, 0.96; CI, 0.94–0.99; P