Impact of new health care policies on the quality of acute myocardial infarction treatment in Swiss hospitals: A before and after observational study

Abstract

Objective: Following a revision of the Swiss Federal Health Insurance Act, the regional hospital planning structure was modified and the hospital financing organized at a national level with the use of diagnosis related groups (SwissDRGs). The aim of this observational study was to determine in an independent way the initial impact of these changes on the quality of hospital treatment, with patients hospitalized for Acute Myocardial Infarction (AMI) being the chosen study group. Methods: We used prospective data from a Swiss clinical registry for AMI. The quality was measured based on the adherence to 10 evidence-based performance indicators for AMI treatment, and on the evaluation of in-hospital outcomes (mortality, complications, length of hospital stay [LOS]) globally and for seven pre-defined vulnerable subgroups. The study compared patient-based data before (2011) and after (2012) the implementation of the reform. Results: The study included 33 matched hospitals, and compared the AMI treatment of 2,491 patients in 2011 (before) and 2,544 in 2012 (after the hospital reform). No significant changes in the evidence-based performance indicators were observed, but an on average one day reduction in the LOS and worse outcomes in one of the pre-defined group of patients were found. The issue of how the clinical team achieved these results was not directly explored due to the underlying registry's unalterable structure. Conclusions: One year after the implementation of a new hospital financing system in Switzerland, the quality of treatment delivered to patients hospitalized for AMI was maintained overall. The worse in-hospital mortality in one pre-defined vulnerable subgroup could reflect the emergence of difficulties for clinical teams to cope with patients demanding extra care and time. Further investigation is warranted.