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Case Survival Reflects Hospital Performance in Cardiac Arrest

TUESDAY, May 21 (HealthDay News) -- Hospitals with high case-survival rates for cardiac arrest tend to have lower incidence rates of inpatient cardiac arrest, according to research published online May 20 in JAMA Internal Medicine.

Lena M. Chen, M.D., of the University of Michigan in Ann Arbor, and colleagues searched a large, national registry to identify hospitals with at least 50 adult in-hospital cardiac arrest cases from 2000 through November 2009. After adjustment for patient and hospital characteristics, the association between the incidence of inpatient cardiac arrest and case-survival rate was assessed.

The researchers identified 102,153 cases of in-hospital cardiac arrest at 358 hospitals, with a median hospital cardiac arrest incidence rate of 4.02 per 1,000 admissions, and a median hospital case-survival rate of 18.8 percent. In unadjusted analyses, the incidence of cardiac arrest was significantly lower at hospitals with higher case-survival rates. The significant correlation persisted after adjustment for patient characteristics, but was attenuated and no longer significant following further adjustment for hospital characteristics. The nurse-to-bed ratio was the modifiable hospital factor that most weakened this relationship.

"Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case mix. This relationship is partially mediated by measured hospital attributes," the authors write. "Performance measures focused on case-survival rates seem an appropriate first step in quality measurement for in-hospital cardiac arrest."

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