Trends in hospital performance in acute myocardial infarction care: a retrospective longitudinal study in Japan

Abstract

Objective: To elucidate the hospital characteristics associated with hospital performance and time trends in acute myocardial infarction (AMI) care using multilevel multivariable analysis of longitudinal data.

Design: Retrospective longitudinal study.

Setting: One hundred and fourteen hospitals in Japan.

Participants: A total of 26 210 AMI patients admitted between 2008 and 2011.

Main outcome measure: A composite score was calculated from five AMI process measures. Hospital performances and time trends were then investigated based on this composite score. Using generalized linear mixed models with random intercepts (indicating hospital baseline performance) and random slopes (indicating trends in improvement), we analyzed the associations between performance and the following factors: hospital ownership, AMI case volume, number of cardiovascular specialists per AMI patient and participation in a public disclosure program.

Results: Hospitals that demonstrated high performance in the composite score were significantly associated with high AMI case volume, municipal ownership and agreement to named disclosure of hospital performance. The following factors were significantly associated with time trends of improvement in performance: public and private ownership, AMI case volume and number of cardiovascular specialists per AMI patient. In addition, higher performances were associated with diminished improvement.

Conclusions: Time trends in improvement were related to baseline performance and several hospital characteristics. Furthermore, hospitals that had agreed to named disclosure of performance were more likely to have better quality of care at the initial point of public disclosure. These findings can inform the decision-making process for quality improvement, and allow a greater understanding and interpretation of disclosed performances in quality measures.

Keywords: multilevel model; public disclosure; quality improvement; quality indicators.