by
Brendon Nafziger, DOTmed News Associate Editor | November 23, 2009
For one, almost three-quarters of hospitals in the early feedback group said they were trying to change heart attack care practices, against slightly less than half of the late feedback group.
But the more important, and dramatic finding, was a 2.5 percent decline in the mean 30-day mortality rates from heart attacks in the early feedback hospitals.
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"We think it's probably multifactorial," says Dr. Tu about the decline. "There's not a simple explanation. Every hospital did something slightly different in response to its report card," he says, which could have led to the slight downtick in deaths.
One factor was, in response to early feedback, around 10 to 25 percent of hospitals changed their protocol for delivering anti-blood-clotting drugs to heart attack victims. In the baseline review, Dr. Tu and his colleagues noticed that some hospitals made patients wait to see a specialist, or get transferred to an ICU, before they could get the thrombolytic drugs -- a delay that cost around 10 or 11 minutes, precious time that could be saved by letting the attending ER physician deliver the medicine instead.
Dr. Tu stresses organizational changes, such as instituting standardized protocols and checklists for admitting and discharging patients, might have led to the greatest gains. And these gains are not trivial. "Our estimate is the report card may have saved 250 people in 2004," he says.
From a statistical perspective, Dr. Tu says the findings of the slight improvement in mortality rates in heart attacks are strong, but not perfect. "There's about a one in 20 chance it was [due to] chance, and 19 in 20 it was real," he says. "We chose the most conservative method for analyzing the data. I'm pretty convinced it was the real thing."
Still, he does acknowledge that many have been skeptical of the findings, and believe because the benefits were so modest, they might not be reproduced.
But Dr. Tu counters that though few results were statistically significant, nearly the entire trend was headed one way. "Not a single indicator of our almost 20 [favored] the delayed feedback group," he says. "All our indicators were pointing in one direction."
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