Measure non-adherence on any admission | ||
Measure | 90-day adjusted* HR (95% CI) | 365-day adjusted* HR (95% CI) |
Acute myocardial infarction | ||
Aspirin at arrival | 6.90 (0.85 to 56.13) | 6.71 (1.54 to 29.30) |
β blocker at arrival | 3.82 (0.76 to 19.08) | 4.25 (1.28 to 14.07) |
PCI <90 min | NA | NA |
Aspirin (D/C) | 6.23 (0.83 to 46.78) | 2.51 (0.35 to 18.27) |
Beta blocker (D/C) | NA | 1.65 (0.23 to 11.96) |
ACEI/ARB | 1.58 (0.58 to 4.27) | 1.24 (0.62 to 2.51) |
Smoking counselling | 2.51 (0.71 to 8.93) | 1.56 (0.54 to 4.52) |
Arrival group measure | 3.46 (1.31 to 9.15) | 2.71 (1.28 to 5.74) |
Discharge group measure | 2.85 (1.47 to 5.56) | 2.18 (1.32 to 3.59) |
Failure on any measure, any admission | 2.67 (1.51 to 4.73) | 2.08 (1.36 to 3.19) |
Heart failure | ||
ACEI/ARB for LVSD | 1.98 (1.10 to 3.55) | 1.54 (1.03 to 2.29) |
LV assessment | 1.88 (0.83 to 4.28) | 1.74 (0.92 to 3.29) |
Discharge instruction | 1.22 (0.84 to 1.78) | 1.23 (0.97 to 1.55) |
Smoking counselling | 2.22 (0.83 to 5.95) | 2.28 (1.24 to 4.21) |
Patient information measures | 1.19 (0.82 to 1.72) | 1.25 (0.99 to 1.57) |
Failure on any measure, any admission | 0.97 (0.74 to 1.28) | 1.03 (0.85 to 1.24) |
Pneumonia | ||
Antibiotic <4 h | 1.13 (0.68 to 1.85) | 1.05 (0.74 to 1.49) |
Blood culture timing | 1.86 (1.07 to 3.21) | 1.59 (1.10 to 2.30) |
O2 assessment | NA | NA |
Antibiotic selection | 1.42 (0.55 to 3.70) | 1.28 (0.69 to 2.36) |
Influenza vaccine assessment | 0.97 (0.57 to 1.68) | 1.04 (0.71 to 1.52) |
Pneumonia vaccine assessment | 1.06 (0.71 to 1.59) | 1.18 (0.90 to 1.56) |
Smoking counselling | 1.19 (0.53 to 2.68) | 1.59 (0.93 to 2.70) |
Arrival group measures | 1.46 (0.98 to 2.18) | 1.20 (0.91 to 1.57) |
Health maintenance measures | 1.07 (0.73 to 1.56) | 1.10 (0.86 to 1.44) |
Failure on any measure, any admission | 1.23 (0.87 to 1.75) | 1.24 (0.98 to 1.58) |
Time-weighted measure non-adherence | ||
Measure | 90-day adjusted* HR† (95% CI) | 365-day adjusted* HR† (95% CI) |
Acute myocardial infarction | ||
Aspirin at arrival | 1.05 (0.69 to 1.59) | 1.16 (0.96 to 1.39) |
Beta blocker at arrival | 1.16 (0.98 to 1.37) | 1.20 (1.06 to 1.36) |
PCI <90 min | NA | NA |
Aspirin (D/C) | 1.20 (0.98 to 1.47) | 1.10 (0.90 to 1.34) |
Beta blocker (D/C) | NA | 1.05 (0.86 to 1.28) |
ACEI/ARB | 1.05 (0.95 to 1.16) | 1.02 (0.95 to 1.09) |
Smoking counselling | 1.10 (0.97 to 1.25) | 1.05 (0.94 to 1.17) |
Arrival group measures | 1.14 (0.98 to 1.33) | 1.15 (1.03 to 1.27) |
Discharge group measures | 1.22 (1.09 to 1.38) | 1.18 (1.08 to 1.29) |
Average non-adherence score | 1.16 (1.04 to 1.29) | 1.17 (1.08 to 1.26) |
0–49% adherence (vs all) | 3.06 (1.30 to 7.16) | 3.06 (1.72 to 5.43) |
50–99% adherence (vs all) | 2.45 (1.19 to 5.06) | 1.53 (0.84 to 2.78) |
Heart failure | ||
ACEI/ARB for LVSD | 1.06 (0.99 to 1.13) | 1.04 (0.99 to 1.08) |
LV assessment | 1.03 (0.93 to 1.14) | 1.03 (0.95 to 1.11) |
Discharge instruction | 1.01 (0.97 to 1.05) | 1.01 (0.99 to 1.04) |
Smoking counselling | 1.07 (0.96 to 1.19) | 1.06 (0.99 to 1.14) |
Patient information measures | 0.99 (0.95 to 1.03) | 1.01 (0.98 to 1.03) |
Average non-adherence score | 0.97 (0.91 to 1.03) | 0.99 (0.95 to 1.03) |
0–49% adherence (vs all) | 0.68 (0.46 to 1.01) | 0.80 (0.62 to 1.03) |
50–99% adherence (vs all) | 1.31 (0.94 to 1.81) | 1.30 (1.03 to 1.63) |
Pneumonia | ||
Antibiotic <4 h | 1.01 (0.96 to 1.06) | 1.00 (0.97 to 1.04) |
Blood culture timing | 1.06 (1.00 to 1.12) | 1.04 (1.00 to 1.08) |
O2 assessment | NA | NA |
Antibiotic selection | 1.04 (0.95 to 1.15) | 1.03 (0.97 to 1.10) |
Influenza vaccine assessment | 1.00 (0.94 to 1.05) | 1.00 (0.97 to 1.04) |
Pneumonia vaccine assessment | 1.00 (0.96 to 1.04) | 1.02 (0.99 to 1.05) |
Smoking counselling | 1.03 (0.95 to 1.12) | 1.05 (0.99 to 1.11) |
Arrival group measures | 1.04 (0.94 to 1.15) | 1.02 (0.95 to 1.09) |
Health maintenance measures | 1.00 (0.96 to 1.04) | 1.01 (0.98 to 1.04) |
Average non-adherence score | 1.03 (0.97 to 1.11) | 1.05 (1.006 to 1.10) |
0–49% adherence (vs all) | 1.44 (0.90 to 2.31) | 1.54 (1.11 to 2.14) |
50–99% adherence (vs all) | 1.15 (0.78 to 1.69) | 1.14 (0.87 to 1.48) |
↵* Confounders included patient's age, gender, race, socioeconomic status, comorbidities at admission, DNR order on admission for arrival measures, DNR order anytime during hospitalisation for other measures, and transfer to Massachusetts General Hospital for non-arrival measures.
↵† Per 10% decrease in adherence score.
ACEI/ARB, angiotensin-converting enzyme inhibitor/angiotensin receptor blockade; D/C, discharge; DNR, do not resuscitate; LV, left ventricle; LVSD, left ventricular systolic dysfunction; NA, not available; PCI, percutaneous coronary intervention.