Quality of care of Medicare beneficiaries with acute myocardial infarction: who is included in quality improvement measurement?

摘要: Objectives: To determine the proportion of older patients hospitalized with acute myocardial infarction (AMI) incorporated in a commonly used set AMI quality indicators. Design: Retrospective analysis medical record database. Setting: Nongovernmental U.S. care hospitals. Participants: Medicare for between January 1994 and February 1996. Measurements: Proportion aged 65 classified as ideal candidates (without absolute or relative contraindications) six Centers & Medicaid Services indicators: aspirin (admission, discharge), beta-blocker angiotensin-converting enzyme (ACE) inhibitors at discharge, time to reperfusion therapy. Results: Of 149,996 eligible admission therapies, 10.1% were therapy, 65.0% aspirin, 34.7% beta-blockers. 116,919 discharge 47.7% 17.6% beta-blockers, 15.2% ACE inhibitors. More than one-quarter (26.8%) all ineligible any indicators; this increased age, ranging from 23.7% 69 30.2% 85 older. Conclusion: A substantial not included process measurement, excluded higher successively age groups. The data highlight need additional research effective treatment strategies whom evidence base clinical decision-making remains weak.