The Association of Duration of participation in get with the guidelines-resuscitation with quality of Care for in-Hospital Cardiac Arrest

Abstract

Background: Large variations exist in the care processes and outcomes for patients who experience in-hospital cardiac arrest (IHCA). We examined if Get With The Guidelines-Resuscitation (GWTG-R) participation duration was associated with improved care processes.

Methods and results: We calculated an overall process composite performance score for IHCA patients using five guideline-recommended process measures, calculating composite adherence among patients, and grouped at hospitals based on GWTG-R participation duration. Trend tests using logistic regression with generalized estimating equations examined the impact of participation duration on quality. Using multivariable regression models adjusting for patient factors, hospital factors, secular trends, and GWTG-R participation duration, we assessed the association between participation duration and process composite performance. We examined 149,551 patients from 447 hospitals (2000-2012). Over the study period we saw decreases in: median age of cardiac arrest (71 to 67 years), the proportion of whites (69.2% to 66.6%), and pulseless ventricular tachycardia/ventricular fibrillation frequency (32.3% to 17.3%). Hospitals were increasingly more likely to be in urban locations and have higher nurse-to-bed ratios. Guideline performance adherence improved with participation duration for several individual process measures and overall process composite performance: process composite score (P-value trend P < .001), confirmation of endotracheal tube (P < .001 trend), monitored/witnessed event (P < .001 trend), time to first chest compressions ≤1 minute (P < .001 trend), and time to vasopressor use ≤5 minutes (P-value trend = 0.0004). There was a decrease in adherence as duration of participation increased for time to defibrillation ≤2 minutes (P-value trend = 0.005). After adjusting for several factors including calendar time, GWTG-R participation duration was independently associated with improved process composite performance (OR 1.05 per year, 95% CI 1.03-1.07).

Conclusions: GWTG-R participation duration was associated with a significant improvement in IHCA quality of care, yet significant opportunities remain to find ways to maximize quality of care in this high-risk patient group.