Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Feb;50(2):124-30.
doi: 10.1097/MLR.0b013e31822d5d17.

Variability in case-mix adjusted in-hospital cardiac arrest rates

Raina M Merchant  1 , Lin Yang, Lance B Becker, Robert A Berg, Vinay Nadkarni, Graham Nichol, Brendan G Carr, Nandita Mitra, Steven M Bradley, Benjamin S Abella, Peter W Groeneveld; American Heart Association Get With the Guideline-Resuscitation Investigators
Affiliations

Variability in case-mix adjusted in-hospital cardiac arrest rates

Raina M Merchant et al. Med Care. 2012 Feb.

Abstract

Background: It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability.

Objectives: Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates.

Research design: Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals.

Participants: Adult patients with IHCA.

Measures: Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score.

Results: We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; P<0.0001).

Conclusions: Case-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Distribution of case-mix adjusted in-hospital cardiac arrest event rates
The x-axis represents the case-mix adjusted arrest event rate and the y-axis represents the percentage of hospitals participating in the Get With the Guidelines-Resuscitation registry (n=433 hospitals).
See this image and copyright information in PMC

References

    1. Hodgetts TJ, Kenward G, Vlackonikolis I, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54:115–123. - PubMed
    1. Schein RM, Hazday N, Pena M, et al. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388–1392. - PubMed
    1. Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22:244–247. - PubMed
    1. Smith AF, Wood J. Can some in-hospital cardio-respiratory arrests be prevented? A prospective survey. Resuscitation. 1998;37:133–137. - PubMed
    1. Berwick DM, Calkins DR, McCannon CJ, et al. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA. 2006;295:324–327. - PubMed

Publication types

MeSH terms