Abstract 102: The Association of Patient Navigator Program Features and Hospital Strategies with Processes and Outcome Metrics in Acute Myocardial Infarction and Heart Failure

Abstract

Background: Association between hospital site-led structure, system and process changes, number of site-initiated technologies, the perceived value of program-directed services aimed at promoting quality improvement and process and outcome metrics achieved are unknown after a 2-year acute myocardial infarction and heart failure (AMI-HF) quality program. Methods: After participation in the Patient Navigator Program, hospitals (n=35) completed surveys on the implementation of structure, system and process changes, number of site-initiated technologies, and the perceived value of program directed educational calls and webinars, quality-focused site visits, use of a list-serv that facilitated site coordinator communication and data reports. Univariate analyses assessed the associations of each factor with 30-day unadjusted AMI-HF rehospitalization and in-hospital risk adjusted AMI death and 14 AMI-HF process metrics. Results: When hospital structure, system and process changes were high, sites were more likely to improve 30-day HF re-hospitalization, p =0.014. The number of site-initiated technologies and the value of using a list-serv to communicate with other program sites were not associated with outcome or process metric changes from baseline to 2 years. Sites that rated program-led educational calls and webinars as a high value were more likely to improve AMI-HF self-care education documentation, p =0.049. Sites that rated quality-related site visits as high value were more likely to improve left ventricular systolic dysfunction evaluation, p =0.035 and 30-day unadjusted AMI-HF rehospitalization rates ( p =0.021 and 0.007, respectively). Sites who rated the value of data reports more highly were less likely to improve 30-day unadjusted AMI rehospitalization, p =0.006 and more likely to improve 30-day HF rehospitalization, p =0.033. Conclusion: Hospital-initiated structure-system-process changes and Patient Navigator Program-directed services that were perceived as high value, especially site visits and data reports, were more likely to be associated with improved 30-day HF re-hospitalization rates and some process improvements compared to baseline.