In This Edition
- Pay-for-performance associated with limited benefits on quality in acute myocardial infarction patients.
- Meta-analysis finds increased risk of acute myocardial infarction with use of rosiglitazone.
- Rosiglitazone increases risk of heart failure, but not acute myocardial infarction or death, interim analysis shows.
- Surgery versus prolonged conservative treatment for severe sciatica.
- Predicting poor outcomes in upper gastrointestinal bleeds.
- Discharging patients with unresolved medical issues.
Background: In 2003, the Centers for Medicare and Medicaid Services (CMS) instituted a pay-for-performance (P4P) pilot program in which participating hospitals would be reimbursed more if they met specific quality standards of care for patients with certain conditions, including acute myocardial infarction (AMI). It is unknown if this type of financial incentive produces improvements in the processes or outcomes of care.
Study design: Observational cohort.
Setting: 500 hospitals across the U.S.
Synopsis: This study compared compliance with CMS quality indicators in the treatment of more than 100,000 patients with acute non-ST-elevation myocardial infarction at 54 participating and 446 non-participating hospitals in the P4P pilot. They found no significant difference in mortality or in a composite measure of the six quality indicators but a slight improvement in two of the six quality indicators (aspirin at discharge and smoking cessation counseling). They did not find that P4P adversely affected indicators not subject to financial incentives.
Bottom line: P4P is associated with limited improvements in compliance with CMS quality indicators in patients with AMI.
Citation: Glickman SW, Ou F-S, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007 Jun;297(21):2373-2380.
Background: Rosiglitazone (Avandia) is one of two approved oral thiazolidinedione drugs used for diabetic control. Muraglitazar, another thiazolidinedione drug, was not approved for market due to adverse cardiovascular outcomes. The cardiovascular effects of rosiglitazone had not previously been evaluated.