• Jeffrey H Silber, Alexander F Arriaga, Bijan A Niknam, Alexander S Hill, Richard N Ross, and Patrick S Romano.
• Center for Outcomes Research, Children's Hospital of Philadelphia.
• Med Care. 2018 May 1; 56 (5): 416-423.

BackgroundFailure-to-rescue (FTR), originally developed to study quality of care in surgery, measures an institution's ability to prevent death after a patient becomes complicated.ObjectivesDevelop an FTR metric modified to analyze acute myocardial infarction (AMI) outcomes.Research DesignSplit-sample design: a random 20% of hospitals to develop FTR definitions, a second 20% to validate test characteristics, and an out-of-sample 60% to validate results.SubjectsOlder Medicare beneficiaries admitted to short-term acute-care hospitals for AMI between 2009 and 2011.MeasuresThirty-day mortality and FTR rates, and in-hospital complication rates.ResultsThe 60% out-of-sample validation included 234,277 patients across 1142 hospitals that admitted at least 50 patients over 2.5 years. In total, 72.1% of patients were defined as Medically Complicated (complex on admission or subsequently developed a complication or died without a recorded complication) of whom 19.3% died. Spearman r between hospital risk-adjusted 30-day mortality and FTR was 0.89 (P<0.0001); Mortality versus Complication=-0.01 (P=0.6198); FTR versus Complication=-0.10 (P=0.0011). Major teaching hospitals displayed 19% lower odds of FTR versus non-teaching hospitals (odds ratio=0.81, P<0.0001), while hospitals as a group defined by teaching hospital status, comprehensive cardiac technology, and having good nursing mix and staffing, displayed a 33% lower odds of FTR (odds ratio=0.67, P<0.0001) versus hospitals without any of these characteristics.ConclusionsA modified FTR metric can be created that has many of the advantageous properties of surgical FTR and can aid in studying the quality of care of AMI admissions.

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