AIM: Good DTB times do not equate to other positive quality measures

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Under the American Heart Association’s (AHA) Get With the Guidelines program, door-to-balloon (DTB) times have decreased significantly over time; however, there was minimal correlation between DTB time improvement and changes in other quality measures or mortality, according to a study in the Aug. 10/24 issue of the Archives of Internal Medicine.

Tracy Y. Wang, MD, from the departments of medicine/cardiology at Duke Clinical Research Institute in Durham, N.C., and colleagues examined 101 hospitals (43,678 patients with acute MI) in the Get With the Guidelines program. For each hospital, DTB time improvement from 2005 to 2007 was correlated with changes in composite Centers for Medicare & Medicaid Services/Joint Commission on Accreditation of Healthcare Organizations (CMS/JCAHO) core measure performance and in-hospital mortality.

Between 2005 and 2007, the researchers reported that hospital geometric mean DTB time decreased from 101 to 87 minutes.

They found that the mean overall hospital composite CMS/JCAHO core measure performance increased from 93.4 to 96.4 percent, and mortality rates were 5.1 percent and 4.7 percent in the early and late periods, respectively.

The authors noted that improvement in hospital DTB time, however, was not significantly correlated with changes in composite quality performance ( r = –0.06; P = .55) or with in-hospital mortality ( r = 0.06; P = .58). After adjustment for patient mix, they found that hospitals with the most improvement in DTB time did not have significantly greater improvements in either CMS/JCAHO measure performance or mortality.

Wang and colleagues concluded that their results emphasized the “important need for comprehensive acute MI quality-improvement efforts, rather than focusing on single process measures.”