{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T04:30:11Z","timestamp":1793075411186,"version":"4.5.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2015,3,17]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Performance metrics currently focus on the measurement of the application of guideline-indicated medications without considering the appropriate dosing of these drugs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We studied 39\u2009291 patients from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC\/AHA Guidelines (CRUSADE) registry with non\u2013ST-segment elevation acute coronary syndromes. We evaluated hospital variability in the composite use of American College of Cardiology\/American Heart Association guideline\u2013recommended therapies (adherence) and the proportion of treated patients with the recommended dose of heparins or a glycoprotein IIb\/IIIa antagonist (safety), and its association with risk-adjusted in-hospital mortality and bleeding. The rates of composite guideline adherence (median, 85%; 25th, 75th percentile, 82, 88) and antithrombotic dosing safety (median, 53%; 25th, 75th percentile, 45%, 60%) varied among hospitals. Correlation between hospital composite adherence and safety metrics was significant but low (\n              <jats:italic>r<\/jats:italic>\n              =0.16,\n              <jats:italic>P<\/jats:italic>\n              =0.008). Risk-adjusted in-hospital mortality was inversely related to both guideline adherence (odds ratio-10% increment, 0.80; 95% confidence interval, 0.67\u20130.94) and safety metrics (odds ratio-10% increment, 0.90; 95% confidence interval, 0.83\u20130.98). Safety was inversely related to major bleeding (adjusted odds ratio-10% increment, 0.93; 95% confidence interval, 0.87\u20130.98). In comparison with hospitals with low adherence and safety (\u2264median performance) metrics, those with mixed performance metrics (high adherence and low safety, low adherence and high safety) had intermediate risk-adjusted mortality rates, whereas hospitals with above-average performance on both metrics (&gt;median performance) had a trend for lowest risk adjusted mortality rates (odds ratio 0.83; 95% confidence interval, 0.68\u20131.01). Hospitals with high safety had lower bleeding rates in comparison to those with low safety.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>Guideline adherence and dosing safety appeared to provide independent and complementary information on hospital bleeding and mortality, supporting the need for broader metrics of quality that should include measures of both guideline-based care and safety.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.114.013451","type":"journal-article","created":{"date-parts":[[2015,2,17]],"date-time":"2015-02-17T04:27:34Z","timestamp":1424147254000},"page":"980-987","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Doing the Right Things and Doing Them the Right Way"],"prefix":"10.1161","volume":"131","author":[{"given":"Rajendra H.","family":"Mehta","sequence":"first","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita Y.","family":"Chen","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen P.","family":"Alexander","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Magnus","family":"Ohman","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Roe","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"From Duke Clinical Research Institute and Duke University Medical Center, Durham, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520430045037"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.279.17.1351"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.13.1670"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.10.1269"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.08.067"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.164.2.203"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)00996-7"},{"key":"e_1_3_3_9_2","unstructured":"Centers for Medicare and Medicaid Services Website. http:\/\/www.cms.hhs.gov\/quality\/hospital. 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Washington, DC: National Academy Press; 2001."},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.24.3108"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1800"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1197\/aemj.9.11.1146"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.17.2096"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(03)00388-0"},{"key":"e_1_3_3_17_2","unstructured":"The CRUSADE National Quality Improvement Website. http:\/\/www.CRUSADEQI.com. Accessed April 24 2008."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02336-7"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.18.2027"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.828541"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/73.1.13"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.10.004"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.22.2557"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.16.1897"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000128373.90851.7B"},{"key":"e_1_3_3_27_2","volume-title":"To Err is Human: Building a Safer Health System","author":"Institute of Medicine","year":"1999","unstructured":"Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academic Press; 1999."},{"key":"e_1_3_3_28_2","unstructured":"Joint Commission on Accreditation of Healthcare Organization. http:\/\/www.jointcommission.org. Accessed April 24 2006."},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01531-0"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.9.1301"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.09.013"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.14.1746"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.171760"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.114.013451","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:55:20Z","timestamp":1715583320000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.114.013451"}},"subtitle":["Association Between Hospital Guideline Adherence, Dosing Safety, and Outcomes Among Patients With Acute Coronary Syndrome"],"short-title":[],"issued":{"date-parts":[[2015,3,17]]},"references-count":32,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2015,3,17]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.114.013451"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.114.013451","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,3,17]]},"assertion":[{"value":"2014-09-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-01-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-02-16","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}