Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study

Shazia Rehman, Xi Li, Chao Wang, Muhammad Ikram, Erum Rehman and Meina Liu
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Shazia Rehman: Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China
Xi Li: Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China
Chao Wang: Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China
Erum Rehman: School of Mathematics and Statistics, Southwest University of Finance and Economics, Chengdu 610074, China
Meina Liu: Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China

IJERPH, 2019, vol. 16, issue 20, 1-12

Abstract: A wide variation exists in the practice patterns of acute myocardial infarction (AMI) care worldwide, leading to differences in clinical outcomes. This study aims to evaluate the quality of process care and its impact on in-hospital outcomes among AMI patients in Pakistan, as no such study has been conducted in Pakistan thus far based upon recommended guidelines. We investigated a sample of 2663 AMI patients across 11 territory hospitals in Punjab province of Lahore, Faisalabad, Multan, Rawalpindi, and Islamabad from January 1, 2016 to December 31, 2017, with an in-hospital mortality rate of 8.6%. We calculated compliance rates of quality indicators (QIs) for all eligible patients. The association between process care and in-hospital outcome was assessed using hierarchical generalized linear model that adjusted for patient and hospital characteristics. In addition, we examined the effect of patient composite scores on clinical outcomes. Aspirin (73.08%) and clopidogrel (67.86%) indicated relatively better conformance than other QIs. The percutaneous coronary intervention also showed significantly low adherence. All QIs showed no significant association with in-hospital mortality. In contrast, 4 out of 8 QIs were observed positively correlated with in-hospital length of stay (LOS). The overall patient composite score was found to be statistically significant with in-hospital LOS. The assessment of quality of care showed low adherence to clinical care recommendations, and increased adherence was associated with longer in-hospital LOS among AMI patients. Evaluation of valid QIs for AMI treatment and their impact on in-hospital outcomes is an important tool for improving health care delivery in the overall AMI population in Pakistan. Low adherence to performance measures strongly compel to focus on guideline-based tools for AMI in Pakistan.

Keywords: acute myocardial infarction; quality of care; in-hospital outcomes; compliance measurement; composite score (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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