ACP American College of Physicians - Internal Medicine - Doctors for Adults

Effective Clinical Practice

Variations among Hospitals in the Quality of Care for Heart Failure

Effective Clinical Practice, March/April 2000.

Context. Determining variations in quality of care among hospitals can help direct attention to poorly performing institutions.

Practice Pattern Examined. The proportion of patients with congestive heart failure meeting various quality criteria in 69 hospitals.

Hospital Selection. The hospitals were voluntary participants in a quality improvement program in five states (Colorado, Connecticut, Georgia, Oklahoma, and Virginia).

Patient Selection. All patients with congestive heart failure discharged from the participating hospitals during a 15-month period in 1995 to 1996 (or, for hospitals with more than 50 eligible patients, a random sample of 50 patients). The total sample consisted of 2077 patients.

Data Source. Documentation in the hospital medical record of left ventricular function, discharge medications, and discharge instructions.

Results. Left ventricular function was determined in 72% of patients (range across hospitals, 18% to 97%). Among patients with left ventricular systolic dysfunction, 79% were prescribed an angiotensin-converting enzyme inhibitor (range, 54% to 94%). Only 23% of the patients prescribed angiotensin-converting enzyme inhibitors received the target dose (range, 0% to 60%). Sixty-four percent of patients were counseled about the importance of a low-sodium diet at discharge (range, 25% to 97%), but only 8% were counseled about daily weight monitoring (range, 0% to 30%).

Conclusion. Our results show substantial hospital-to-hospital variation in the quality of care for patients with heart failure.