Every year, about one million people suffer a heart attack (acute myocardial infarction or AMI). AMI is among the leading causes of hospital admission for Medicare beneficiaries, age 65 and older.
Scientific evidence indicates that the following processes of care represent the best practices for the treatment of AMI. Higher scores are better.
The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels, and the heart can’t get enough oxygen. This can cause a heart attack. Chewing an aspirin as soon as symptoms of a heart attack begin may help reduce the severity of the attack. This chart shows the percent of heart attack patients who were given (or took) aspirin within 24 hours of arrival at the hospital.
Higher percentages are better.
ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat patients with heart failure and are particularly beneficial in those patients with heart failure and decreased function of the left side of the heart. Early treatment with ACE inhibitors and ARBs in patients who have heart failure symptoms or decreased heart function after a heart attack can also reduce their risk of death from future heart attacks. ACE inhibitors and ARBs work by limiting the effects of a hormone that narrows blood vessels, and may thus lower blood pressure and reduce the work the heart has to perform. Since the ways in which these two kinds of drugs work are different, your doctor will decide which drug is most appropriate for you. If you have a heart attack and/or heart failure, you should get a prescription for ACE inhibitors or ARBs if you have decreased heart function before you leave the hospital.
Smoking increases your risk for developing blood clots and heart disease that can result in a heart attack, heart failure or stroke. Smoking causes your arteries to thicken and your blood vessels to narrow. Fat and plaque stick to the walls of your arteries, which makes it harder for blood to flow. Reduced blood flow to your heart may result in chest pain, high blood pressure, and an increased heart rate. Smoking is also linked to lung disease and cancer, and can cause premature death. It is important that you get information to help you quit smoking before you leave the hospital. Quitting may help prevent another heart attack.
Higher percentages are better.
Beta blockers are a type of medicine that is used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. Beta blockers relieve the stress on your heart by slowing the heart rate and reducing the force with which your heart muscles contract to pump blood. They also help keep blood vessels from constricting in your heart, brain, and body. If you have a heart attack, you should get a prescription for a beta blocker before you leave the hospital.
Higher percentages are better.
The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels and the heart can’t get enough oxygen. This can cause a heart attack. Fibrinolytic drugs are medicines that can help dissolve blood clots in blood vessels and improve blood flow to your heart. You should get them within 30 minutes of arrival at the hospital.
Higher percentages are better.
The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels, and the heart cannot get enough oxygen. This can cause a heart attack. Percutaneous Coronary Interventions (PCI) are procedures that are among the most effective ways to open blocked blood vessels and help prevent further heart muscle damage. A PCI is performed by a doctor to open the blockage and increase blood flow in blocked blood vessels. Improving blood flow to your heart as quickly as possible lessens the damage to your heart muscle. It also can increase your chances of surviving a heart attack. There are three procedures commonly described by the term PCI. These procedures all involve a catheter (a flexible tube) that is inserted, often through your leg, and guided through the blood vessels to the blockage. The three procedures are:
Higher percentages are better.
Average (median) minutes after arrival before fibrinolytic medication received. (A lower number of minutes is better.)
The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels and the heart can’t get enough oxygen. This can cause a heart attack. Fibrinolytic drugs are medicines that can help dissolve blood clots in blood vessels and improve blood flow to your heart. You should get them within 30 minutes of arrival at the hospital.
Higher percentages are better.
If a hospital does not have the facilities to provide specialized heart attack care, it transfers patients with possible heart attack to another hospital that can give them this care.
This measure shows how long it takes, on average, for hospitals to identify patients who need specialized heart attack care the hospital cannot provide and begin their transfer to another hospital.
It shows the average (median) number of minutes it takes from the time patients arrive in the Emergency Department until they are transported to a different hospital.
The heart is a muscle that gets oxygen through blood vessels. Sometimes blood clots can block these blood vessels, and the heart can’t get enough oxygen. This can cause a heart attack. Chewing an aspirin as soon as symptoms of a heart attack begin may help reduce the severity of the attack. This chart shows the percent of heart attack patients who were given (or took) aspirin within 24 hours of arrival at the hospital.
Higher percentages are better.
"ECG" (sometimes called EKG) stands for electrocardiogram. An ECG is a test that can help doctors know whether patients are having a heart attack.
Standards of care say that patients with chest pain or a possible heart attack should have an ECG upon arrival, preferably within 10 minutes.
This measure tells the average (median) number of minutes it takes before patients got an ECG.
Sometimes patients get an ECG done before they get to the hospital (for example, by the ambulance staff). This is counted as "0 minutes."
Blood clots can block blood vessels. Aspirin can help prevent blood clots from forming or help dissolve blood clots that have formed. Following a heart attack, continued use of aspirin may help reduce the risk of another heart attack. Aspirin can have side effects like stomach inflammation, bleeding, or allergic reactions. Talk to your health care provider before using aspirin on a regular basis to make sure it’s safe for you.
Higher percentages are better.
Statins are drugs used to lower cholesterol. Cholesterol is a fat (also called a lipid) that your body needs to work properly. Cholesterol levels that are too high can increase your chance of getting heart disease, stroke, and other problems. For patients who had a heart attack and have high cholesterol, taking Statins can lower the chance that they’ll have another heart attack or die.
Heart failure is the most common hospital admission diagnosis in patients age 65 or older, accounting for more than 700,000 hospitalizations among Medicare beneficiaries every year. It is associated with severe functional impairments and high rates of mortality and morbidity.
Substantial scientific evidence indicates that the following processes of care represent the best practices for the treatment of heart failure. Higher scores are better.
Heart failure is a chronic condition. It results in symptoms such as shortness of breath, dizziness, and fatigue. Before you leave the hospital, the staff at the hospital should provide you with information to help you manage the symptoms after you get home. The information should include your
Higher percentages are better.
The proper treatment for heart failure depends on what area of your heart is affected. An important test is to check how your heart is pumping, called an "evaluation of the left ventricular systolic function." It can tell your health care provider whether the left side of your heart is pumping properly. Other ways to check on how your heart is pumping include:
Higher percentages are better.
ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are medicines used to treat patients with heart failure and are particularly beneficial in those patients with heart failure and decreased function of the left side of the heart. Early treatment with ACE inhibitors and ARBs in patients who have heart failure symptoms or decreased heart function after a heart attack can also reduce their risk of death from future heart attacks. ACE inhibitors and ARBs work by limiting the effects of a hormone that narrows blood vessels, and may thus lower blood pressure and reduce the work the heart has to perform. Since the ways in which these two kinds of drugs work are different, your doctor will decide which drug is most appropriate for you. If you have a heart attack and/or heart failure, you should get a prescription for ACE inhibitors or ARBs if you have decreased heart function before you leave the hospital.
Smoking increases your risk for developing blood clots and heart disease, which can result in a heart attack, heart failure or stroke. Smoking causes your blood vessels to thicken. Fat and plaque then stick to the wall of your blood vessels, which makes it harder for blood to flow. Reduced blood flow to your heart may result in chest pain, high blood pressure, and an increased heart rate. Smoking is linked to lung disease and cancer, and can cause premature death. It is important for your health that you get information to help you quit smoking before you leave the hospital.
Higher percentages are better.
Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections.
The timing is important: getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure patients get antibiotics at the right time.
Higher numbers are better.
Surgical wound infections can be prevented. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections. Getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure surgery patients get antibiotics at the right time.
Higher numbers are better.
Antibiotics are often given to patients before surgery to prevent infection. Taking these antibiotics for more than 24 hours after routine surgery is usually not necessary. Continuing the medication longer than necessary can increase the risk of side effects such as stomach aches and serious types of diarrhea. Also, when antibiotics are used for too long, patients can develop resistance to them and the antibiotics won’t work as well.
Higher numbers are better.
Many factors influence a surgery patient’s risk of developing a blood clot, including the type of surgery. When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can sometimes cause death.
Treatments to help prevent blood clots from forming after surgery include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs. These treatments need to be started at the right time, which is typically during the period that begins 24 hours before surgery and ends 24 hours after surgery.
Higher numbers are better.
Community acquired pneumonia is a major contributor to illness and mortality in the United States, causing 4 million episodes of illness and nearly one million hospital admissions each year.
Scientific evidence indicates that the following measures represent the best practices for the treatment of community-acquired pneumonia:
The pneumococcal vaccine may help you prevent, or lower the risk of complications of pneumonia caused by bacteria. It may also help you prevent future infections. Patients with pneumonia should be asked if they have been vaccinated recently for pneumonia and, if not, should be given the vaccine.
Higher percentages are better.
Different types of bacteria can cause pneumonia. A blood culture is a test that can help your health care provider identify which bacteria may have caused your pneumonia, and which antibiotic should be prescribed. A blood culture is not always needed, but for patients who are first seen in the hospital emergency department, it is important for the accuracy of the test that blood culture be conducted before any antibiotics are started. It is also important to start antibiotics as soon as possible.
Higher percentages are better.
Smoking damages your lungs and can make it hard to breath. Smoking increases your chances of getting pneumonia or other chronic lung diseases like emphysema and bronchitis. Smoking is also linked to lung cancer, heart disease, and stroke, and can cause premature death. It is important for you to get information to help you quit smoking before you leave the hospital. Quitting may reduce your chance of getting pneumonia again.
Higher percentages are better.
Antibiotics are used to treat adults with pneumonia caused by bacteria. Early treatment with antibiotics can cure bacterial pneumonia and reduce the possibility of complications. This information shows the percent of patients who were given their first dose of antibiotics within 6 hours of arrival at the hospital. Patients who get pneumonia during their stay at the hospital are not counted in this measure.
Higher percentages are better.
Pneumonia is a lung infection that is usually caused by bacteria or a virus. If pneumonia is caused by bacteria, hospitals will treat the infection with antibiotics. Different bacteria are treated with different antibiotics. To learn about how hospitals use a blood test to choose the most effective treatment for pneumonia patients, refer to the Process of Care measure named Percent of Pneumonia Patients Whose Initial Emergency Room Blood Culture Was Performed Prior To The Administration Of The First Hospital Dose Of Antibiotics.
Higher percentages are better.
Flu shots reduce the risk of influenza, a serious and sometimes deadly lung infection that can spread quickly in a community or facility. Hospitals should check to make sure that pneumonia patients, particularly those who are age 50 or older, get a flu shot during flu season to protect them from another lung infection and to help prevent the spread of influenza.
Since a flu shot is effective for just one flu season, the period of time used to calculate this rate is the flu season (from approximately November through March), in contrast to other measures on Hospital Compare, which are generally collected throughout the year.
Higher percentages are better.
Hospitals can reduce the risk of wound infection after surgery by providing the right medicines at the right time on the day of surgery.
Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections.
Hospital staff should make sure patients get the antibiotic that works best for their type of surgery.
Higher numbers are better.
It is often standard procedure to stop patients' usual medications for awhile before and after their surgery. But if patients who have been taking beta blockers suddenly stop taking them, they can have heart problems such as a fast heart beat. For these patients, staying on beta blockers before and after surgery makes it less likely that they will have heart problems.
Higher numbers are better.
Surgical wound infections can be prevented. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery. Hospital staff should make sure patients get the antibiotic that works best for their type of surgery.
Higher numbers are better.
Even if heart surgery patients do not have diabetes, keeping their blood sugar under good control after surgery lowers the risk of infection and other problems. "Under good control" means their blood sugar should be 200 mg/dL or less when checked first thing in the morning.
Higher numbers are better.
Preparing a patient for surgery may include removing body hair from skin in the area where the surgery will be done. Medical research has shown that shaving with a razor can increase the risk of infection. It is safer to use electric clippers or hair removal cream.
Higher numbers are better.
Sometimes surgical patients need to have a urinary catheter, or thin tube, inserted into their bladder to help drain the urine. Catheters are usually attached to a bag that collects the urine.
Surgery patients can develop infections when urinary catheters are left in place too long after surgery. Infections are dangerous for patients, cause longer hospital stays, and increase costs.
This shows the percent of surgery patients whose urinary catheters were removed on the first or second day after surgery. Research shows that most surgery patients should have their urinary catheters removed within 2 days after surgery to help prevent infection.
Higher numbers are better.
Hospitals can prevent surgical wound infections and other complications by keeping the patient’s body temperature near normal during surgery. Medical research has shown that patients whose body temperatures drop during surgery have a greater risk of infection and their wounds may not heal as quickly. Hospital staff should make sure that patients are actively warmed during and immediately after surgery to prevent drops in body temperature.
This measure shows the percent of patients whose body temperature was normal or near normal during the time period 15 minutes before the end of surgery to 30 minutes after anesthesia ended.
Certain surgeries increase the risk that the patient will develop a blood clot (venous thromboembolism). When patients stay still for a long time after some types of surgery, they are more likely to develop a blood clot in the veins of the legs, thighs, or pelvis. A blood clot slows down the flow of blood, causing swelling, redness, and pain. A blood clot can also break off and travel to other parts of the body. If the blood clot gets into the lung, it is a serious problem that can cause death.
To help prevent blood clots from forming after surgery, doctors can order treatments to be used just before or after the surgery. These include blood-thinning medications, elastic support stockings, or mechanical air stockings that help with blood flow in the legs.
Higher numbers are better.
Asthma is a chronic lung condition that causes problems getting air in and out of the lungs. Children with asthma may experience wheezing, coughing, chest tightness and trouble breathing. These symptoms are triggered because the body reacts to environmental changes such as allergens or changes in temperature. Appropriate treatment for asthma can reduce the risk of further attacks. Asthma that is not treated appropriately may cause permanent lung damage, and on rare occasion, death.
National guidelines for treating children with asthma in the hospital recommend using reliever medication (like albuterol) and systemic corticosteroid medication (oral and IV medication that reduces inflammation and controls symptoms) in the severe phase and gradually cutting down the dosage of medications to provide control of the asthma symptoms:
This measure tells you the percentage of children with asthma who were given reliever medication (like albuterol) while hospitalized. Relievers are medications that relax the bands of muscle surrounding the airways and are used to quickly make breathing easier.
National guidelines for treating children with asthma recommend using relievers in the severe phase and gradually cutting down the dosage of medications to provide control of asthma symptoms.
Although there are guidelines for medication therapy for children with asthma, there is evidence that these guidelines are not being consistently followed. Using the appropriate medications will lower the risk of severe illness and/or death.
Higher percentages are better.
This measure tells you the percentage of children with asthma who were given oral or IV steroid medications while hospitalized. These medications work in the body as a whole, rather than just on the lungs. They help reduce inflammation and control allergic reactions.
Oral or IV steroid medications control severe asthma well. That is why they are important for hospital care. Unfortunately, they can cause serious side effects when used long-term. That is why they are mainly used for severe episodes or chronic severe asthma, which cannot be controlled with other medications (like inhaled or oral bronchodilators and anti-inflammatory medications).
Higher percentages are better.
This measure tells you the percentage of children with asthma and their caregivers who were given a Home Management Plan of Care document while hospitalized.
Because asthma is a chronic condition, controlling a child’s asthma symptoms at home will help reduce the risk of further attacks. Knowledge about the disease and its treatment is the key to good asthma control. Asthma that is not managed effectively may lead to more visits to the hospital. Medications can help prevent asthma symptoms and attacks from starting in the first place and can reduce how often attacks happen and severity of the attacks. It is important for children with asthma and their caregivers to know how to prevent asthma symptoms and attacks before they happen.
The Home Management Plan of Care helps children with asthma and their caregivers develop a plan to manage the child’s asthma symptoms and to know when to take action. It should address all of the following:
Higher percentages are better.
The four outpatient imaging efficiency measures (OP-8 through OP-11) are produced from Medicare administrative claims for the fee-for-service population and no additional data submission is required by hospitals. The OIE measures are not risk adjusted; they are calculated as raw/observed rates after the exclusion and inclusion criteria are applied.
The purpose of these measures is to promote high-quality efficient care. Specifically, each of the following measures was created to reduce unnecessary exposure to contrast materials and /or radiation, ensure adherence to evidence-based medicine and practice guidelines, and promote efficiency defined as "absence of waste".
Although MRIs can be helpful for diagnosing low back pain, MRIs can be used too much.
If a number is high, it may mean that the facility is doing unnecessary MRIs for low back pain. For some patients with certain conditions, getting an MRI right away is appropriate care. Patients with these conditions are not included in this measure.
If you have low back pain, you, your doctor, and the medical imaging facility staff should all talk about the best time to do an MRI if you need one.
An MRI (magnetic resonance imaging) is a test that uses a powerful magnetic field and a computer to produce detailed pictures of the inside of the body (bones, organs, and other body parts).
When a screening mammogram shows signs of possible breast cancer, the patient is asked to come back for a follow-up appointment. A follow-up usually means having more tests (mammograms, an ultrasound, or both).
Medical research shows that there may be a problem if a facility has either very low or very high numbers of follow-ups (Note: The numbers that follow are most appropriately applied to women who are 65 or older who have Original Medicare):
A screening mammogram is an x-ray of the breast to check for possible breast cancer.
Combination scans involve additional radiation exposure and risks associated with use of contrast.
For this measure, if a number is very close to 1, it may mean that the facility is routinely giving patients combination CT scans of the abdomen when a single scan is all they need.
Giving patients two scans when they only need one needlessly doubles their exposure to radiation:
Risks of injected contrast include possible harm to the kidneys or allergic reactions. Contrast shouldn’t be used if it isn’t needed.
CT scans of the abdomen are one of the most commonly requested imaging procedures. If you need to have a CT scan of the abdomen, talk to your doctor about what’s best for your medical condition:
The information that follows shows hospital imaging facilities’ use of CT scans of the abdomen. Talk with your doctor about the results you see here and what a facility’s results mean for you and your care.
A CT scan (also called a CAT scan) uses multiple x-rays to produce detailed pictures of the inside of the body (bones, organs, and other body parts).
Standards of quality care say that most patients who are getting a CT scan of the chest should be given a single CT scan rather than a "combination" CT scan. (Although combination CT scans are appropriate for some parts of the body and some medical conditions, combination scans are usually not appropriate for the chest.)
The range for this measure is 0 to 1. If a number is very close to 1, it may mean that the facility is routinely giving patients combination CT scans of the chest when a single scan is all they need.
Giving patients two scans when they only need one needlessly doubles their exposure to radiation:
When contrast is used, there are risks that can include possible harm to the kidneys or allergic reactions (especially if the contrast is injected). To avoid unnecessary risk, contrast should be used only when it is needed. If you need to have a CT scan of the chest, talk with your doctor about what’s best for your medical condition:
The information that follows shows hospital imaging facilities’ use of CT scans of the chest. Talk with your doctor about the results shown here and what a facility’s results mean for you and your care.
Higher rates of serious, but potentially preventable, complications may be a sign of poorer quality hospital care. Hospitals can reduce the chance of these serious complications by following safe practices.
This section shows serious complications that patients with Original Medicare experienced during a hospital stay, and how often patients who were admitted with certain conditions died while they were in the hospital. These complications and deaths can often be prevented if hospitals follow procedures based on best practices and scientific evidence.
The report is based on information from Medicare fee-for-service claims from short term, acute care hospitals and is not case-mix adjusted. Columns are defined as follows:
Patients who died after being admitted to the hospital for surgery to repair an abdominal aortic aneurism (AAA), a weakness in the main artery that supplies blood to the belly and legs. Abdominal aortic aneurisms are serious conditions that can lead to death, if they aren’t repaired before they burst or start to leak blood. The surgery to repair AAA is complex. Higher death rates may be a sign that a hospital has less experienced surgical teams.
Patients who died after being admitted to the hospital for a broken hip (hip fracture). Many older people are admitted to the hospital because they've fallen and broken their hips. Because it's a common, serious problem for older people, hospitals should have procedures in place for safely treating patients with hip fractures, to prevent serious problems that can cause death. Some deaths may be unavoidable, but a hospital with a higher death rate for patients with hip fractures may not be using evidence-based procedures to treat patients with these conditions.
(A composite of six measures)
Patients who were admitted to the hospital with certain conditions, who died while they were in the hospital. Many people are admitted to the hospital because of certain common, serious conditions. Hospitals should have procedures in place for treating these common conditions to prevent serious problems that can cause death. Some deaths may be unavoidable, but a hospital with a higher death rate for these conditions might not be using evidence-based procedures to treat patients with these conditions.
Surgical patients who died after developing serious complications that could have been treated. There's always a risk of serious complication during or after surgery. However, hospitals with trained, well organized, and efficient staff identify these complications quickly and treat them aggressively. Some deaths may be unavoidable. But higher death rates from complications may be a sign that patients weren't watched closely after surgery or that effective action wasn't taken.
During certain medical procedures, there's a chance that the patient's lung will be accidentally punctured. This can cause air to escape and the lung to collapse. Usually, this complication is rare, and sometimes, it's unavoidable. However, if a hospital has a higher rate of this complication, it may be a sign that the hospital is giving poor quality care in this area.
Patients who were unable to breathe after surgery without the help of a ventilator (a machine that helps someone breathe). If patients have breathing problems after surgery, doctors usually order special treatment (respiratory therapy) to make sure they get enough oxygen into their bloodstream. Even so, some patients may not be able breathe on their own, especially if they were very frail or sick to begin with. However, if a hospital has a higher rate of breathing failure among its surgical patients, it may be a sign that it isn’t providing high-quality and effective care.
When patients stay still for a long time after some types of surgery, they're more likely to develop a serious blood clot in the veins of the legs, thighs, or pelvis. This is especially true for patients who are very frail or sick. A blood clot can also break off and travel to other parts of the body. If a blood clot gets into a patient's lung, it’s a serious problem that can cause death. Some patients may get blood clots even though doctors order treatments to prevent them. However, if a hospital has a higher rate of serious blood clots after surgery, it may be a sign that doctors and nurses aren’t doing enough to prevent them.
Surgical wounds may split open after surgery, even when the surgeon sewed the wound up correctly. This may happen when wounds aren't healing well, or because of problems like severe coughing or vomiting. If a hospital has a higher rate of this complication, it may be a sign that doctors and nurses aren’t paying close enough attention to their patients or providing proper care.
During some complicated medical procedures, there’s a chance that a part of the patient’s body will be accidentally cut. Sometimes, it may be unavoidable. But if a hospital has a higher rate of this complication, it may be a sign that the medical staff aren’t using proper techniques when performing these procedures.
(A composite of eight measures)
Higher rates of serious, but potentially preventable, complications may be a sign of poorer quality hospital care. Hospitals can reduce the chance of these serious complications by following safe practices.
This refers to infections caused by a vascular catheter, which is a thin flexible plastic tube inserted into a patient’s vein. Vascular catheters make drawing blood or giving medications easy. Patients who need vascular catheters for a long period of time may need to have them put in during surgery.
Vascular catheters can put patients at risk for infections and serious complications, especially if they are kept in for long periods of time. These might include skin infections at the site where the catheter was inserted and bloodstream infections. Patients who have poor circulation because of diseases such as diabetes have a greater risk of infection.
Hospitals can prevent vascular catheter-associated infections by choosing the best sites for inserting the catheter, using the right catheter material, keeping the site clean, and removing the catheter when it’s no longer needed. Hospitals with high rates of this complication may not be following these procedures.
Lower numbers are better.