Association between a hospital's quality performance for in-hospital cardiac arrest and common medical conditions

Abstract

Background: Public reporting on hospital quality has been widely adopted for common medical conditions. Adding a measure of inpatient survival after cardiac arrest is being considered. It is unknown whether this measure would be redundant, given evidence that hospital organization and culture can have hospital-wide effects on quality. Therefore, we sought to evaluate the correlation between inpatient survival after cardiac arrest and 30-day risk-standardized mortality rates for common medical conditions.

Methods and results: Using data between 2007 and 2010 from a national in-hospital cardiac arrest registry, we calculated risk-standardized in-hospital survival rates for cardiac arrest at each hospital. We obtained risk-standardized 30-day mortality rates for acute myocardial infarction, heart failure, and pneumonia from Hospital Compare for the same period. The relationship between a hospital's performance on cardiac arrest and these other medical conditions was assessed using weighted Pearson correlation coefficients. Among 26 270 patients with in-hospital cardiac arrest at 130 hospitals, survival rates varied across hospitals, with a median risk-standardized hospital survival rate of 22.1% and an interquartile range of 19.7% to 24.2%. There were no significant correlations between a hospital's outcomes for its cardiac arrest patients and its patients admitted for acute myocardial infarction (correlation, -0.12; P=0.16), heart failure (correlation, -0.05; P=0.57), or pneumonia (correlation, -0.15; P=0.10).

Conclusions: Hospitals that performed better on publicly reported outcomes for 3 common medical conditions did not necessarily have better cardiac arrest survival rates. Public reporting on cardiac arrest outcomes could provide new information about hospital quality.

Keywords: heart failure; myocardial infarction; resuscitation.

Figure 1

Study cohort

Figure 2

Distribution of risk-standardized hospital rates of in-hospital cardiac arrest survival

Figure 3A. Correlation between hospitals’ risk-standardized cardiac arrest survival rates and 30-day risk-standardized acute myocardial infarction (AMI) mortality rates

The size of the circle represents the number of patients at each hospital, with the smallest hospital having 34 patients and the largest hospital having 922 patients.

Figure 3B. Correlation between hospitals’ risk-standardized cardiac arrest survival rates and 30-day risk-standardized heart failure (HF) mortality rates

The size of the circle represents the number of patients at each hospital, with the smallest hospital having 34 patients and the largest hospital having 922 patients.

Figure 3C. Correlation between hospitals’ risk-standardized cardiac arrest survival rates and 30-day risk-standardized pneumonia mortality rates

The size of the circle represents the number of patients at each hospital, with the smallest hospital having 34 patients and the largest hospital having 922 patients.