Table 4.
Percent of Hospitals With High Performance* in 2008 by Joint Commission Accreditation Status
| Percent of Hospitals with Performance Over 90%† Adjusted (Actual) | ||||
|---|---|---|---|---|
| Characteristic | Never Accredited (n = 762) | Always Accredited (n = 2,917) | Odds Ratio, Always vs Never (95% CI)† | P Value† |
| AMI | ||||
| Aspirin at admission | 91.8 (71.8) | 93.9 (90.7) | 1.38 (1.00–1.89) | 0.049 |
| Aspirin at discharge | 83.7 (69.2) | 88.2 (85.1) | 1.45 (1.08–1.94) | 0.013 |
| ACE inhibitor for LV dysfunction | 65.1 (65.8) | 77.2 (76.5) | 1.81 (1.32–2.50) | <0.001 |
| Beta blocker at discharge | 84.7 (69.4) | 90.9 (88.4) | 1.80 (1.33–2.44) | <0.001 |
| Smoking cessation advice | 91.1 (81.3) | 95.9 (94.1) | 2.29 (1.31–4.01) | 0.004 |
| PCI received within 90 min | 21.5 (16.2) | 29.9 (29.8) | 1.56 (0.71–3.40) | 0.265 |
| Thrombolytic agent within 30 min | 21.4 (21.3) | 22.7 (23.6) | 1.08 (0.42–2.74) | 0.879 |
| Composite AMI score | 80.5 (56.6) | 88.2 (85.9) | 1.82 (1.37–2.41) | <0.001 |
| Heart failure | ||||
| Discharge instructions | 27.0 (26.3) | 38.9 (39.3) | 1.72 (1.30–2.27) | <0.001 |
| Assessment of LV function | 76.2 (45.0) | 89.1 (88.8) | 2.54 (1.95–3.31) | <0.001 |
| ACE inhibitor for LV dysfunction | 58.0 (51.4) | 67.8 (68.5) | 1.52 (1.21–1.92) | <0.001 |
| Smoking cessation advice | 84.2 (62.3) | 90.3 (89.2) | 1.76 (1.28–2.43) | <0.001 |
| Composite heart failure score | 38.2 (27.6) | 61.5 (64.6) | 2.57 (2.03–3.26) | <0.001 |
| Pneumonia | ||||
| Oxygenation assessment | 100 (98.2) | 100 (99.8) | 4.38 (1.20–1.32) | 0.025 |
| Pneumococcal vaccination | 44.1 (40.3) | 57.3 (58.2) | 1.70 (1.36–2.12) | <0.001 |
| Timing of initial antibiotic therapy | 74.3 (79.1) | 84.2 (82.7) | 1.85 (1.40–2.46) | <0.001 |
| Smoking cessation advice | 76.2 (54.6) | 85.8 (84.2) | 1.89 (1.42–2.51) | <0.001 |
| Initial antibiotic selection | 51.8 (47.4) | 51.0 (51.8) | 0.97 (0.76–1.25) | 0.826 |
| Composite pneumonia score | 69.3 (59.4) | 85.3 (83.9) | 2.58 (2.01–3.31) | <0.001 |
| Overall composite | 69.0 (47.5) | 83.8 (82.0) | 2.32 (1.76–3.06) | <0.001 |
Abbreviations: ACE angiotensin-converting enzyme; AMI, acute myocardial infarction; CI, confidence interval; LV, left ventricular; PCI, percutaneous coronary intervention.
High performance defined as performance rates of 90% or more.
Performance calculated as the proportion of all eligible patients who received the indicated care. Percent of hospitals with performance over 90% estimated based on multivariate logistic regression adjusting for baseline performance, profit status, bed size, rural setting, critical access hospital status, and region except for PCI received within 90 minutes and thrombolytic agent within 30 minutes which did not adjust for critical access hospital status. Odds ratios, CIs, and P values based on the logistic regression analysis.