Evaluation of Cardiac Care Units and Myocardial Infarction

Abstract

Selected items of medical history, physical and laboratory findings, diagnoses, and treatment methods in 770 patients were stored by computer to assess utilization and effectiveness of medical care in a cardiac care unit. Utilization was expressed in terms of the distribution of final diagnoses and selected, cardiac complications in addition to occupancy rate. Effectiveness was expressed in terms of incidence and location of deaths from theoretically preventable causes, and in terms of resuscitation results, in addition to mortality in acute myocardial infarction. The same data permitted a study of prognostic factors in acute myocardial infarction. Excess mortality was associated with diabetes, previous heart failure, and age of 65 years or greater. Systematic collection of routinely available clinical information permits studies of hospital operations and of specific diseases, provided basic assumptions about objectives of care are acceptable.Medical auditing involves the enumeration of relatively rou¬ tine activities, as contrasted to experi¬ mental activities, in the general area of patient care. The purposes of such audits could include analyses of hospi-(Dr. McGuire). tal operating efficiency, studies of professional personnel performance, or clinical research concerning se¬ lected diseases. In order for a single collection of information to serve more than one purpose, the volume of data recorded for each patient must be relatively great, and there must be more uniformity in definitions of medical terms and standards than is routinely followed in medical prac¬ tice.While major limitations thus hin¬ der useful auditing of total hospital populations covering a wide range of diseases and activities, the grouping of patients into special care facilities for related diseases may make audit¬ ing more successful. This effort was undertaken at the University of Vir¬ ginia cardiac care unit in 1967. An¬ swers to 92 questions concerning items of medical history, physical and laboratory findings, complications, treatment methods, and results of treatment in 770 consecutive patients were stored by computer. A review of this experience suggested that in¬ dices of unit effectiveness other than the commonly used death rate in acute myocardial infarction are desir¬ able, and that specific deficiencies in medical management techniques can be revealed. The application of these same data to a study of prognostic factors in myocardial infarction was also illustrated. MethodsA study form was completed on every patient admitted to a four-bed cardiac care unit during a 36-month period in 1967 to 1970. In addition to the usual identifying data, coded entries were made from a list of ten possible diagnoses, 27 electrocardiographic findings and arrhythmias, and 25 drug or electrical treatment methods. Each patient was classified in terms of one of five possible primary diagnoses (listed in Table 1), and in terms of any of several po¬ tentially applicable secondary diagnoses, such as hypertension, diabetes, valvular heart disease. Va...