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Administrative Data Feedback for Effective Cardiac Treatment : AFFECT , a cluster randomized trial . CONTEXT Hospital report cards are increasingly being implemented for quality improvement despite lack of strong evidence to support their use . OBJECTIVE To determine whether hospital report cards constructed using linked hospital and prescription administrative databases are effective for improving quality of care for acute myocardial infarction ( AMI ) . DESIGN The Administrative Data Feedback for Effective Cardiac Treatment ( AFFECT ) study , a cluster randomized trial . SETTING AND PATIENTS Patients with AMI who were admitted to 76 acute care hospitals in Quebec that treated at least 30 AMI patients per year between April 1 , 1999 , and March 31 , 2003 . INTERVENTION Hospitals were randomly assigned to receive rapid ( immediate ; n = 38 hospitals and 2533 patients ) or delayed ( 14 months ; n = 38 hospitals and 3142 patients ) confidential feedback on quality indicators constructed using administrative data . MAIN OUTCOME MEASURES Quality indicators pertaining to processes of care and outcomes of patients admitted between 4 and 10 months after randomization . The primary indicator was the proportion of elderly survivors of AMI at each study hospital who filled a prescription for a beta-blocker within 30 days after discharge . RESULTS At follow-up , adjusted prescription rates within 30 days after discharge were similar in the early vs late groups ( for beta-blockers , odds ratio [ OR ] , 1.06 ; 95 % confidence interval [ CI ] , 0.82-1.37 ; for angiotensin-converting enzyme inhibitors , OR , 1.17 ; 95 % CI , 0.90-1.52 ; for lipid-lowering drugs , OR , 1.14 ; 95 % CI , 0.86-1.50 ; and for aspirin , OR , 1.05 ; 95 % CI , 0.84-1.33 ) . In addition , adjusted mortality was similar in both groups , as were length of in-hospital stay , physician visits after discharge , waiting times for invasive cardiac procedures , and readmissions for cardiac complications . CONCLUSIONS Feedback based on one-time , confidential report cards constructed using administrative data is not an effective strategy for quality improvement regarding care of patients with AMI . A need exists for further studies to rigorously evaluate the effectiveness of more intensive report card interventions .
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Intervention_Other
Effective Cardiac Treatment
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Intervention_Physical
:
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Intervention_Educational
hospital report cards constructed using linked hospital and prescription administrative databases
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Intervention_Other
Administrative Data Feedback for Effective Cardiac Treatment
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Intervention_Educational
rapid
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Intervention_Educational
delayed
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Intervention_Educational
confidential feedback on quality indicators constructed using administrative data
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Intervention_Other
.
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Intervention_Educational
report card interventions
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Intervention_Other
.
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Outcome_Physical
Effective Cardiac Treatment
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Outcome_Other
quality of care
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Outcome_Mortality
adjusted mortality
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Outcome_Other
length of in-hospital stay
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Outcome_Other
physician visits after discharge
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Outcome_Other
waiting times for invasive cardiac procedures ,
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Outcome_Other
readmissions for cardiac complications
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Outcome_Other
effectiveness
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Participant_Condition
acute myocardial infarction
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Participant_Condition
AMI
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Participant_Sample-size
2533
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Participant_Sample-size
3142