Quality of XXXX care predicts the development of cardiovascular events: results of the AMD-QUASAR study.

@entity1 @entity3916 @entity6 @entity164 @entity165
OBJECTIVE: The QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian @entity6 @entity1 ) study aimed to assess whether a quality-of-care summary score predicted the development of cardiovascular (CV) events in @entity1 with @entity164 2 @entity6 . RESEARCH DESIGN AND METHODS: In 67 @entity6 clinics, data on randomly selected @entity1 were extracted from electronic medical records. The score was calculated using process and outcome indicators based on monitoring, targets, and treatment of @entity3916 , blood pressure, LDL @entity165 , and microalbuminuria. The score ranged from 0 to 40. RESULTS: Overall, 5,181 @entity1 were analyzed; 477 (9.2%) @entity1 developed a CV event after a median follow-up of 28 months. The incidence rate (per 1,000 @entity1 -years) of CV events was 62.4 in @entity1 with a score of <15, 41.0 in those with a score between 20 and 25 and 36.7 in those with a score of >25. Multilevel analysis, adjusted for clustering and case-mix, showed that the risk to develop a new CV event was 84% higher in @entity1 with a score of <15 (incidence rate ratio [IRR] = 1.84; 95% confidence interval [CI] 1.29-2.62) and 17% higher in those with a score between 15 and 25 (IRR = 1.17; 95% CI 0.93-1.49) compared with those with a score of >25. Mean quality score varied across centers from 16.5    7.5 to 29.1    6.3. When the score was tested as the dependent variable, it emerged that 18% of the variance in the score could be attributed to setting characteristics. CONCLUSIONS: Our study documented a close relationship between quality of @entity6 care and long-term outcomes. A simple score can be used to monitor quality of care and compare the performance of different centers/physicians.
