QUALITY OF CARE FOR MEDICARE PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION - A 4-STATE PILOT-STUDY FROM THE COOPERATIVE CARDIOVASCULAR PROJECT

Objective.-To develop and test indicators of the quality of care for p atients with acute myocardial infarction (AMI). Design.-Retrospective medical record review. Setting.-All acute care hospitals in Alabama, C onnecticut, Iowa, and Wisconsin. Patients.-All hospitalizations for Me dicare patients discharged with a principal diagnosis of AMI between J une 1, 1992, and February 28, 1993, were identified (N=16 869). Main O utcome Measure.-Percentage of patients receiving appropriate intervent ions as defined by 11 quality-of-care indicators derived from clinical practice guidelines that were modified and updated in consultation wi th a national group of physicians and other health care professionals. Results.-We abstracted data from 16 124 (96%) of the hospitalizations , representing 14 108 primary hospitalizations and 2016 hospitalizatio ns resulting from transfers. Potential exclusions to the use of standa rd treatments in AMI care were common with 90% and 70% of patients hav ing potential exclusions for thrombolytics and beta-blockers, respecti vely. In cohorts of ''ideal candidates'' for specific interventions, 8 3% received aspirin, 69% received thrombolytics, and 70% received hepa rin during the initial hospitalization; 77% received aspirin and 45% r eceived beta-blockers at discharge. Conclusions.-These data demonstrat e that many Medicare patients may not be ideal candidates for standard AMI therapies, but these treatments are underused, even in the absenc e of discernible contraindications. Hospitals and physicians who apply these quality indicators to their practices are likely to find opport unities for improvement.