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Quality of care of patients hospitalized with acute coronary syndromes

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Abstract:

Abstract Background: 

Measurement and improvement of quality of care is a priority issue in health care. Patients hospitalized with acute coronary syndromes (ACS) constitute a high-risk population whose care, if shown to be suboptimal on the basis of available research evidence, may benefit from quality improvement interventions. Aim: 

To evaluate the quality of in-hospital care for patients with ACS, using explicit quality indicators. Methods: 

Retrospective case note review was undertaken of 397 patients admitted to three teaching hospitals in Brisbane, Queensland, Australia, between 1 October 2000 and 17 April 2001. The main out­come measures were 12 process-of-care quality indicators, calculated as either: (i) the proportion of all patients who received specific interventions or (ii) the proportion of ideal patients who received ­specific interventions (i.e. patients with clear indi­cations and lacking contraindications). Results: 

Quality indicators with values above 80% included: (i) patient selection for thrombolysis (100%) and discharge prescription of beta-blockers (84%), (ii) antiplatelet agents (94%) and (iii) lipid-lowering agents (82%). Indicators with values between 50% and 80% included: (i) timely per­formance of electrocardiogram (ECG) on admission (61%), (ii) early coronary angiography (75%), (iii) measurement of serum lipids (71%) and (iv) discharge prescription of angiotensin-converting-enzyme (ACE) inhibitors (73%). Indicators with values <50% included: (i) timely administration of thrombolysis (35%), (ii) non-invasive risk assessment (23%) and (ii) formal in-hospital and post-hospital cardiac rehabilitation (47% and 7%, respectively). Conclusion: 

There were delays in performing ECG and administering thrombolysis to patients who presented to emergency departments with ACS. Improvement is warranted in use of non-invasive procedures for identifying high-risk patients who may benefit from coronary revascularization as well as use of serum lipid measurements, ACE inhibitors and cardiac rehabilitation. (Intern Med J 2002; 32: 502−511)

Keywords: acute coronary syndromes; indicators; quality of care

Document Type: Research Article

DOI: http://dx.doi.org/10.1046/j.1445-5994.2002.00267.x

Affiliations: 1: Department of Internal Medicine, Princess Alexandra Hospital, 2: Department of Medicine, University of Queensland, 3: Department of Internal Medicine, Royal Brisbane Hospital and

Publication date: November 1, 2002

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