Setting National Hospital Standards Could Boost Cardiac Care11/12/10
FRIDAY, Nov. 12 (HealthDay News) -- Around the nation, hospitals
refer to themselves as "stroke centers of excellence" or "chest
pain centers," the implication being those facilities offer
top-notch care for stroke and heart attacks.
But current programs for certifying, accrediting or recognizing
hospitals as providers of the best cardiovascular or stroke care
are falling short, according to an American Heart
Association/American Stroke Association advisory.
"Right now, it's not always clear what is just a marketing term and what actually truly distinguishes the quality of a center," said Dr. Gregg Fonarow, an American Heart Association spokesman and professor of cardiovascular medicine at the University of California, Los Angeles.
A review of the available data found no clear relationship
between having a special designation as a heart attack or stroke
care center and the care the hospitals provide or, even more
important, how patients fare.
To change that, the American Heart Association and the American
Stroke Association are jointly developing a comprehensive stroke
and cardiovascular care certification program that should serve as
a national standard.
The goal is to help patients, insurers and others have more
reliable information about where they are most likely to receive
the most up-to-date, evidence-based care available, Fonarow
"There is a value to having a trusted source develop a certification program that clinicians, insurers and the public can use to understand which hospitals are providing exceptional cardiovascular and stroke care, including achieving high-quality outcomes," he added.
The program, which will take about two years to develop and will
likely be done in partnership with other major medical
organizations, will cover emergency situations such as heart attack
and stroke, but also heart failure management and coronary bypass
surgery, Fonarow said.
The advisory is published online Nov. 12 and in the Dec. 7 print
Typically, recognition and certification programs require that
hospitals put certain procedures in place, but they don't monitor
how well hospitals are adhering to the practices or whether patient
outcomes are improving, said Fonarow, lead author of the
And those are the better certification programs. Other
self-proclaimed "centers of excellence" may simply be terms dreamed
up by marketing departments.
A review of the evidence about the impact of various recognition
and certification programs on patient outcomes was mixed, he said.
For example, since 2003 the Society of Chest Pain Centers has
offered accreditation to hospitals that meet certain quality of
care criteria for heart attack patients.
But a study found that on average, accredited hospitals were
only adhering to evidence-based guidelines on two of five measures,
according to background information in the article. And there was
no difference in mortality rates.
Because cardiovascular disease and stroke are major causes of
death and disability in the United States, improved care through
comprehensive accreditation is badly needed, Fonarow said.
It's widely recognized that if you have a stroke or a heart
attack, the quality of care you'll receive varies widely from
hospital to hospital.
Some hospitals have 24-hour a day catheterization labs for
treating a deadly type of heart attack (ST-segment elevation
myocardial infarction, or STEMI), and many have different policies
governing when and whether they give the recommended medicine after
stroke, among other variables.
"The quality of care being provided and the outcomes achieved by hospitals can determine whether you are going to live or die from the heart attack or stroke or be severely disabled," Fonarow said. "And that may depend on which center you get taken to."
Dr. Clifford Kavinsky, an interventional cardiologist at Rush
University Medical Center in Chicago, said a national certification
program is sorely needed.
"As technology and medicine advances, and we become more cognizant of the importance of timely care -- particularly for patients with acute stroke and heart attack, where minutes count -- you want to make sure that the hospitals where ambulances take the patients are equipped to provide the treatments necessary for these patients," Kavinsky said. "For that reason, it's important hospitals have accreditation and certification in doing these kinds of advanced treatments."
Measuring hospital performance and patient outcomes, however, is
a major undertaking, Kavinsky said.
"To do so is a very large task requiring manpower and expense," Kavinsky said. "Who is going to pay for it? There has to be some incentive for hospitals, whether it's insurance reimbursement or reputation and recognition that brings them more business."
The certification program will likely build upon the American
Heart Association/American Stroke Association's
Get With the Guidelines program, which encourages hospitals
to adopt procedures for resuscitation, stroke and heart failure
based on the most recent guidelines for optimal care.
The American Heart Association's
Get With the Guidelinesprogram has more on its recommendations for stroke and heart
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