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Expertise and infrastructure capacity impacts acute coronary syndrome outcomes
journal contribution
posted on 2018-01-01, 00:00 authored by C M Astley, I Ranasinghe, D Brieger, C J Ellis, J Redfern, T Briffa, B Aliprandi-Costa, T Howell, S G Bloomer, G Gamble, Andrea DriscollAndrea Driscoll, K K Hyun, C J Hammett, D P ChewObjective Effective translation of evidence to practice may depend on systems of care characteristics within the health service. The present study evaluated associations between hospital expertise and infrastructure capacity and acute coronary syndrome (ACS) care as part of the SNAPSHOT ACS registry.
Methods A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured.
Results Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P < 0.001) and the prescription of guideline therapies observed a tendency for an association with (531/1329 (40.0%), 733/1656 (44.3%) and 603/1402 (43.0%) for low, intermediate and high expertise capacity respectively; P = 0.056), but not rehabilitation (474/1329 (35.7%), 603/1656 (36.4%) and 535/1402 (38.2%) for low, intermediate and high expertise capacity respectively; P = 0.377). Higher expertise capacity was associated with a lower incidence of major adverse events (152/1329 (11.4%), 142/1656 (8.6%) and 149/149 (10.6%) for low, intermediate and high expertise capacity respectively; P = 0.026), as well as adjusted mortality within 18 months (low vs intermediate expertise capacity: odds ratio (OR) 0.79, 95% confidence interval (CI) 0.58–1.08, P = 0.153; intermediate vs high expertise capacity: OR 0.64, 95% CI 0.48–0.86, P = 0.003).
Conclusions Both higher-level expertise in decision making and infrastructure capacity are associated with improved evidence translation and survival over 18 months of an ACS event and have clear healthcare design and policy implications.
Methods A survey collected hospital systems and process data and our analysis developed a score to assess hospital infrastructure and expertise capacity. Patient-level data from a registry of 4387 suspected ACS patients enrolled over a 2-week period were used and associations with guideline care and in-hospital and 6-, 12- and 18-month outcomes were measured.
Results Of 375 participating hospitals, 348 (92.8%) were included in the analysis. Higher expertise was associated with increased coronary angiograms (440/1329; 33.1%), 580/1656 (35.0%) and 609/1402 (43.4%) for low, intermediate and high expertise capacity respectively; P < 0.001) and the prescription of guideline therapies observed a tendency for an association with (531/1329 (40.0%), 733/1656 (44.3%) and 603/1402 (43.0%) for low, intermediate and high expertise capacity respectively; P = 0.056), but not rehabilitation (474/1329 (35.7%), 603/1656 (36.4%) and 535/1402 (38.2%) for low, intermediate and high expertise capacity respectively; P = 0.377). Higher expertise capacity was associated with a lower incidence of major adverse events (152/1329 (11.4%), 142/1656 (8.6%) and 149/149 (10.6%) for low, intermediate and high expertise capacity respectively; P = 0.026), as well as adjusted mortality within 18 months (low vs intermediate expertise capacity: odds ratio (OR) 0.79, 95% confidence interval (CI) 0.58–1.08, P = 0.153; intermediate vs high expertise capacity: OR 0.64, 95% CI 0.48–0.86, P = 0.003).
Conclusions Both higher-level expertise in decision making and infrastructure capacity are associated with improved evidence translation and survival over 18 months of an ACS event and have clear healthcare design and policy implications.
History
Journal
Australian health reviewVolume
42Issue
3Pagination
277 - 285Publisher
CSIRO PublishingLocation
Clayton, Vic.Publisher DOI
ISSN
0156-5788Language
engPublication classification
C1 Refereed article in a scholarly journal; C Journal articleCopyright notice
2018, AHHAUsage metrics
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systems of carehealthacute coronary syndromehospital infrastructureexpertise capacityScience & TechnologyLife Sciences & BiomedicineHealth Care Sciences & ServicesHealth Policy & ServicesST-SEGMENT ELEVATIONNEW-ZEALANDMYOCARDIAL-INFARCTIONSECONDARY PREVENTIONTASK-FORCEMANAGEMENTAUSTRALIAGUIDELINESCAREREHABILITATION
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