Quality of care and in-hospital resource use in acute myocardial infarction: Evidence from Japan

Sungchul Park, Jason Lee, Hiroshi Ikai, Tetsuya Otsubo, Naoto Ukawa, Yuichi Imanaka

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objectives: To determine the association between quality of care in process and outcome measures and in-hospital resource use among patients admitted for acute myocardial infarction (AMI) in Japan. Methods: We analyzed 23,512 AMI patients across 150 hospitals in Japan between April 2008 and March 2011. The exposure measure was inpatient hospital resource use, which was calculated from the sum of all hospital fees for healthcare services provided to AMI patients. Hospitals were then categorized into quartiles based on a risk-adjusted in-hospital resource use index. Quality of care was assessed using three process measures (in-hospital prescription of aspirin, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) and two outcome measures (7-day and 30-day in-hospital mortality). Process and outcome measures were analyzed with multilevel logistic regression models that adjusted for patient and hospital characteristics. Results: No significant differences in process measures were observed across the quartiles of in-hospital resource use. In contrast, hospitals with the lowest resource use were significantly associated with poorer outcomes (7-day in-hospital mortality OR: 1.851 [95% CI 1.327-2.582]; 30-day in-hospital mortality OR: 1.706 [95% CI 1.259-2.312]) than hospitals with higher resource use. Conclusion: Poorer quality of care in outcome measures was significantly associated with lower resource utilization among AMI patients in Japanese hospitals, but process measures did not show similar associations.

Original languageEnglish
Pages (from-to)264-272
Number of pages9
JournalHealth Policy
Issue number3
StatePublished - Aug 2013

Bibliographical note

Funding Information:
This study was supported in part by a Health Sciences Research Grant from the Ministry of Health, Labour and Welfare (MHLW) , and a Grant-in-aid for Scientific Research from the Japan Society for the Promotion of Science (JSPS) . We are deeply grateful to all participating hospitals and technical staff of the Quality Improvement/Indicator Project (QIP).


  • Acute myocardial infarction
  • In-hospital resource use
  • Japan
  • Outcome and process assessment
  • Quality of care


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