Measuring the quality of care in small countries: the empirical analysis of 30-day mortality following acute myocardial infarction and ischaemic stroke in Latvia

Health Policy ◽  
2020 ◽  
Vol 124 (7) ◽  
pp. 695-700
Author(s):  
Jacopo Lenzi ◽  
Guido Noto ◽  
Ilaria Corazza ◽  
Jana Lepiksone ◽  
Maria Pia Fantini
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Quality Of Care ◽  
Ischaemic Stroke ◽  
Empirical Analysis ◽  
Small Countries ◽  
The Empirical Analysis

The impact of sex, gender and healthcare system on quality of care among young adults with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Raparelli ◽  
L Pilote ◽  
H Behlouli ◽  
J Dziura ◽  
H Bueno ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Healthcare System ◽  
Quality Indicators ◽  
Funding Source ◽  
Post Discharge ◽  
Single Payer

Abstract Background The quality of care among young adults with acute myocardial infarction (AMI) may be related to biological sex, psycho-socio-cultural (gender) determinants or healthcare system-level factors. Purpose To examine whether sex, gender, and the type of healthcare system influence the quality of AMI care among young adults. Methods A total of 4,564 AMI young adults (<55 years) (59% women, 47 years, 66% US) were analyzed from the VIRGO and GENESIS-PRAXY studies consisting of single-payer (Canada, Spain) versus multipayer (US) systems. For each patient treated in each system we calculated a quality of care score (QCS) for pre-AMI (1-year pre admission), in-hospital, and post-AMI (1-year post discharge) phases of care (number of quality indicators received divided by the total number [range=0–100%], with higher scores indicating better quality). Ordinal logistic or linear regression models, and 2-way interactions between sex, gender and healthcare system were tested. Results Women in the multipayer system had the highest risk factor burden. Across the phases of care for AMI, 20% of quality indicators were missed in both sexes. High stress, earner status, and social support were associated with a higher QCS in the pre-AMI phase, whereas only employment and earner status were associated with QCS in all other phases. In the pre-AMI phase, women had higher QCS than men, mainly in the single-payer system (adjusted-OR=1.85, 95% CI 1.46,2.35 vs. 1.07, 95% CI 0.84,1.36, P-interaction= 0.002). Regardless of sex, only employment status had a greater effect in the multipayer system (adjusted-OR=0.59, 95% CI 0.44,0.78 vs 1.13, 95% CI 0.89,1.44, P-interaction <0.001). In the in-hospital phase, women had a lower QCS than men, especially in the multipayer system (adjusted-mean-difference: −2.48, 95% CI-3.87, −1.08). Employment was associated with a higher QCS (2.0, 95% CI 0.9–3.17, P-interaction >0.05). Finally, in the post-AMI phase, men and women had a lower QCS, predominantly in the multipayer system. However, primary earners had higher QCS regardless of system. Conclusion Sex, gender, and healthcare system affected the quality of care after AMI. Women had a poorer in-hospital than men and both women and men had suboptimal post-discharge care. Being unemployed lowered the quality of care, more so in the multipayer system. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health and Research (CIHR)

Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006

2008 ◽  
Vol 156 (6) ◽  
pp. 1045-1055 ◽  
Author(s):  
Eric D. Peterson ◽  
Bimal R. Shah ◽  
Lori Parsons ◽  
Charles V. Pollack ◽  
William J. French ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Quality Of Care ◽  
National Registry

scholarly journals Monitoring quality of care in acute myocardial infarction patients using retrospective registry data

2018 ◽  
Vol 30 (5) ◽  
pp. 344-350
Author(s):  
Giovanni Veronesi ◽  
Antonella Zambon ◽  
John F Beltrame ◽  
Francesco Gianfagna ◽  
Giovanni Corrao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Quality Of Care ◽  
Registry Data ◽  
Monitoring Quality

Abstract 13776: The Impact of Race on In-hospital Quality of Care Among Young Adults With Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Diana Benea ◽  
Valeria Raparelli ◽  
hassan behlouli ◽  
Louise Pilote ◽  
Rachel Dryer
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Adults ◽  
Quality Of Care ◽  
Clinical Characteristics ◽  
Hospital Quality ◽  
P Value ◽  
White Race

Introduction: The extent to which race influences in-hospital quality of care among young adults with acute myocardial infarction (AMI) is unknown. We examined racial differences in in-hospital quality of AMI care in young adults and described the patient and/or clinical characteristics associated with potential disparities in care. Methods: Data from the GENESIS-PRAXY (Canada) and the VIRGO (U.S.) prospective cohorts of young adults with AMI were analyzed. Among a total of 4,048 adults with AMI (≤55 years) (median=49 years [IQR 44-52], 22% non-white, 58% women), we calculated an in-hospital quality of care score (QCS) for AMI (quality indicators divided by total, with higher scores indicating better care) based on AHA quality of care standards, reporting data disaggregated by race. We categorized race as white versus non-white, which included Black, Asian and North American Indigenous populations. Results: This cohort was comprised of 906 non-white individuals and 3142 white individuals. Non-white adults exhibited a clustering of adverse cardiac risk factors, psychosocial risk factors and comorbidities versus whites; they had higher rates of hypertension, diabetes, alcohol abuse and prior AMI and lower rates of physical activity. They were more likely to have a low SES and receive low social support, and were less likely to be employed, a primary earner, or married/living with a partner. Non-white individuals were also more likely to experience a NSTEMI and less likely to receive cardiac rehabilitation, smoking cessation counseling as well as dual antiplatelet therapy at discharge. Furthermore, non-white individuals had a lower crude QCS than whites (QCS=69.99 vs 73.29, P-value<0.0001). In the multivariable model adjusted for clinical and psychosocial factors, non-white race (LS Mean Difference=-1.49 95%CI -2.87, -0.11, P-value=0.0344) was independently associated with a lower in-hospital QCS. Conclusion: Non-white individuals with AMI exhibited higher rates of adverse psychosocial and clinical characteristics than white individuals yet non-white race was independently associated with lower in-hospital quality of care. Interventions are needed to improve quality of AMI care in non-white young adults.

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