The Challenge of Designing Key Performance Indicators for Academic Hospitals

Background: This study assesses whether patients with ischemic heart disease receive comparable care and achieve similar outcomes compared to the rest of patients in the department of medicine at our tertiary academic center. Methods: This retrospective study examined the level of care received by all patients who were admitted to the Internal Medical Services at King Abdulaziz University Hospital from January 2010 through December 2012. A number of potential performance indicators were evaluated to ascertain level of care, including clinical deterioration with unplanned intensive care unit transfers, in-hospital complications, in-hospital mortality, and the rate of 30-day readmission. The t test or Mann-Whitney U-test was used to compare means and medians, respectively. The chi-square test was used to compare categorical variables. Results: Of 3838 patients, about a fifth of ischemic heart disease patients (19.3%) required intensive care unit transfer (P < 0.001). Patients admitted through the emergency department were the largest group to require subsequent intensive care unit transfer (65.9% of all cases). The length of stay was significantly shorter in patients admitted to the cardiac care unit, compared with those admitted to other services (3.5 [1.5] days versus 5.8 [5.5] days for patients admitted to other units; P < 0.001). Thirty-day readmission rate was significantly lower in ischemic heart disease patients (11.7%) compared with non- ischemic heart disease cases (18.5%) (P < 0.0001). Conclusion: Although patients with ischemic heart disease had a higher risk of being mechanically ventilated or emergently transferred to the intensive care unit, they had lower readmission rates than non- ischemic heart disease patients.