Variations in the quality of care of patients with acute myocardial infarction among Swiss university hospitals

Objectives. The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial inf-arction (AMI) patients among three Swiss academic medical centres. Design. Cross-sectional study. Setting. Three Swiss university hospitals. Study participants. We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or secondary diagnosis code [International Classification of Diseases, 10th revision (ICD-10)] of AMI. We abstracted medical records for information on demographic characteristics, risk factors, symptoms, and findings at admission. We also recorded the main ECG and laboratory findings, as well as hospital and discharge management and treatment. We excluded patients transferred to another hospital and who did not meet the clinical definition of AMI. Main outcome measures. Percentage of patients receiving appropriate intervention as defined by six quality of care indicators derived from clinical practical guidelines. Results. Among 577 eligible patients with AMI in this study, the mean (SD) age was 68.2 (13.9), and 65 % were male. In the assessment of the quality indicators we excluded patients who were not eligible for the procedure. Among cohorts of ‘ideal can-didates ’ for specific interventions, 64 % in hospital A and 73 % in hospital C had reperfusion within 12 hours either with throm