Table 2. Adherence to Quality Metrics, In-Hospital Outcomes, and 30-Day Outcomes by Dual-Eligibility Quintilesa.
| Variable | Overall (N = 258 995) | Quintile 1 (range, 0% to <13.3%) (n = 57 640) | Quintile 2 (range, 13.3% to <17.4%) (n = 70 336) | Quintile 3 (range, 17.4% to <23.2%) (n = 50 950) | Quintile 4 (range, 23.2% to <31.9%) (n = 49 100) | Quintile 5 (range, 31.9%-83.3%) (n = 30 969) | P value | Quintile 1 vs quintile 5 | |
|---|---|---|---|---|---|---|---|---|---|
| Standard difference, % | Absolute difference, % (95% CI) | ||||||||
| Achievement measures | |||||||||
| ACEI, ARB, or ARNI at discharge | 46 826 (92.9) | 9440 (92.5) | 11 722 (93.1) | 9713 (92.7) | 9919 (93.6) | 6032 (91.9) | <.001 | 2.3 | 1.0 (0.5 to 1.6) |
| Evidence-based specific β-blockers | 60 250 (88.6) | 12 653 (89.8) | 16 177 (87.9) | 12 243 (88.8) | 11 857 (88.4) | 7320 (88.1) | <.001 | 5.7 | 1.8 (1.2 to 2.3) |
| Measure LV function | 220 466 (99.1) | 48 613 (99.2) | 59 779 (99.4) | 43 277 (99.1) | 42 672 (99.2) | 26 125 (98.1) | <.001 | 10.1 | 1.3 (1.2 to 1.5) |
| Postdischarge appointment for patients with HF | 100 828 (62.6) | 24 017 (67.8) | 27 736 (64.0) | 18 667 (57.7) | 19 087 (61.7) | 11 321 (59.6) | <.001 | 17.1 | 6.3 (5.7 to 6.9) |
| HF defect-free care (100% adherence) | 158 854 (70.0) | 37 094 (74.0) | 43 703 (71.4) | 29 348 (65.8) | 30 344 (69.4) | 18 365 (67.3) | <.001 | 14.9 | 6.4 (5.9 to 6.9) |
| Secondary outcomes | |||||||||
| In-hospital mortality | 8746 (3.4) | 1815 (3.1) | 2354 (3.3) | 1969 (3.9) | 1607 (3.3) | 1001 (3.2) | <.001 | 0.5 | 0.0 (−0.1 to 0.2) |
| Length of stay, median (range), db | 4 (3-7) | 4 (3-6) | 4 (3-7) | 4 (3-7) | 4 (3-7) | 4 (3-7) | <.001 | 7.7 | 0.27 (0.22 to 0.32) |
| Quality measures | |||||||||
| Aldosterone antagonist at discharge | 19 551 (34.0) | 4184 (33.8) | 5408 (34.5) | 4328 (38.7) | 3372 (30.2) | 2259 (32.3) | <.001 | 3.3 | 2.7 (1.7 to 3.8) |
| Hydralazine nitrate at discharge | 1057 (26.2) | 122 (32.7) | 255 (26.3) | 187 (34.4) | 216 (17.9) | 277 (29.3) | <.001 | 7.5 | 6.7 (2.7 to 10.8) |
| Anticoagulation for atrial fibrillation or atrial flutter | 73 765 (81.4) | 18 054 (83.2) | 20 225 (84.3) | 14 734 (80.6) | 13 583 (79.0) | 7169 (76.0) | <.001 | 18.1 | 7.5 (6.8 to 8.2) |
| DVT prophylaxis | 89 017 (82.7) | 18 668 (83.1) | 23 687 (81.4) | 16 963 (86.4) | 17 725 (80.3) | 11 974 (82.9) | <.001 | 0.6 | 0.3 (−0.3 to 0.9) |
| Influenza vaccination during influenza season | 79 945 (85.7) | 17 710 (85.2) | 22 260 (87.1) | 16 074 (87.1) | 15 244 (84.7) | 8657 (82.4) | <.001 | 7.5 | 1.2 (0.6 to 1.9) |
| Pneumococcal vaccination | 155 021 (81.2) | 34 358 (81.1) | 41 897 (80.9) | 31 540 (82.3) | 29 960 (81.1) | 17 266 (80.2) | <.001 | 2.3 | 0.3 (−0.2 to 0.7) |
| Reporting measures | |||||||||
| Discharge instructions | 173 034 (93.4) | 37 302 (93.3) | 46 906 (93.4) | 34 127 (92.9) | 35 092 (94.8) | 19 607 (92.3) | <.001 | 3.7 | 0.5 (0.2 to 0.8) |
| Smoking cessation | 18 024 (94.7) | 3183 (94.3) | 4616 (95.5) | 3709 (93.8) | 3992 (94.8) | 2524 (95.0) | .009 | 2.8 | 0.6 (−0.2 to 1.4) |
| β-Blocker at discharge | 69 201 (97.3) | 14 359 (97.2) | 18 695 (97.8) | 13 882 (97.0) | 13 896 (97.1) | 8369 (97.1) | <.001 | 0.9 | 0.1 (−0.2 to 0.4) |
| ICD placed or prescribed at discharge | 25 687 (58.9) | 5324 (62.3) | 6941 (57.8) | 5268 (59.3) | 5204 (58.9) | 2950 (55.1) | <.001 | 14.5 | 5.4 (4.2 to 6.7) |
| 30-d End points | |||||||||
| 30-d All-cause mortality | 23 744 (9.5) | 5416 (9.7) | 6988 (10.3) | 4688 (9.6) | 4243 (8.9) | 2409 (8.0) | <.001 | 5.9 | 1.6 (1.2 to 2.0) |
| 30-d All-cause readmission | 56 629 (22.6) | 11 888 (21.3) | 14 680 (21.6) | 10 988 (22.4) | 11 390 (24.0) | 7683 (25.6) | <.001 | 10.3 | 4.4 (3.8 to 5.0) |
| 30-d HF readmission | 22 228 (8.9) | 4560 (8.2) | 5742 (8.4) | 4315 (8.8) | 4616 (9.7) | 2995 (10.0) | <.001 | 6.4 | 1.8 (1.4 to 2.2) |
Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; DVT, deep vein thrombosis; HF, heart failure; ICD, implantable cardioverter defibrillator; LV, left ventricle.
a
Data are presented as number (percentage) unless otherwise indicated.
b
Continuous variables.