A large portion of Medicare patients who are hospitalized for a heart attack fail to get adequate drug therapy, a federal pilot program has found.
The program, the Cooperative Cardiovascular Project, was launched two years ago by HCFA to determine patterns of care for heart attack patients.
In the four pilot states-Connecticut, Iowa, Alabama and Wisconsin-Medicare peer review organizations collected data from all hospitals to compare their treatment of heart attack patients with practice guidelines issued by the American College of Cardiology and the American Heart Association.
The PROs' findings indicated a "significant opportunity for improvement" in delivering appropriate, often life-saving drugs to those patients, said Stephen Jencks, M.D., senior clinical adviser for HCFA's health standards and quality bureau, at a press briefing.
For example, in the more than 10,000 hospitalizations reviewed by PROs, only 17% of the patients received thrombolytics, drugs that dissolve the clots that cause heart attacks. Of those who did, only 16% received the drugs during the optimal time frame, which is within 30 minutes of arrival at the hospital. The median wait was an hour, with some patients waiting as long as four hours.
According to Dr. Jencks, the gap in appropriate treatment isn't as wide as it first appears, since thrombolytics probably would be appropriate for only about 30% of Medicare patients. Still, like other drug therapies examined in the project, thrombolytics reduce mortality by 1% to 2% among patients for whom the treatment is appropriate.
A more startling finding was that aspirin-which Dr. Jencks said was universally viewed as beneficial for most heart attack patients-was administered in only 64% of the cases studied. Beta blockers, which like thrombolytics aren't appropriate for all patients, were used in 34% of the cases.
HCFA has directed PROs to work closely with hospitals to improve practice patterns, and the project has involved physicians and major cardiac-care organizations.
HCFA will seek to measure improvements in hospital care by gathering data on changes in patient outcomes in individual communities.
"There's no way you can change clinical practice unless you get into an alliance with the people providing care," Dr. Jencks said.
The program will be launched nationally in early 1995 and will eventually assess care patterns for a wide range of conditions, including pneumonia, urinary tract infections and other heart conditions, Dr. Jencks said.
By the end of the initial cardiac project, PROs will have examined some 250,000 medical records for Medicare patients. Due to confidentiality restrictions, the data only will be released to the public in aggregate regional and national statistics, Dr. Jencks said.
Since the Clinton administration has developed a healthcare reform proposal "which clearly gives authority to release information like this," eventually the public will have access to hospital-specific data, he predicted.