Abstract P142: Hospital Management Practices and Associations with MI Processes and Outcomes

Abstract

Background: Improving hospital management practices may improve the quality of cardiac care, but this relationship is poorly understood. One barrier to understanding is limitations of prior surveys of management practices. These surveys are often biased by respondents answering directed questions favorably. We employed a novel survey methodology to minimize this bias, and measured the association between management practices and myocardial infarction (MI) processes and outcomes of care. Methods: We used an innovative telephone survey using open-ended questions to assess 18 management practices in U.S. cardiac units, covering “Lean” management, target setting, and incentives for employees. Each practice was scored from 1 (worst) to 5 (best) and aggregated into a single summary score. We collected MI processes of care and 30-day mortality from the Hospital Compare website for each hospital. Due to ceiling effects, hospitals in the lowest quartile were compared to all other hospitals combined. Regression modeling was used to assess the association between management, process measures, and mortality. Results: In 2010, 665 cardiac units in 50 states, representing approximately half of units in the U.S., were surveyed on management practices. Higher management scores were significantly associated with higher rates of aspirin, ACEI, and beta-blocker use at discharge, receipt of PCI within 90 minutes of arrival for STEMI patients, and lower rates of 30-day mortality (Table). Higher scores demonstrated a trend toward higher rates of smoking cessation counseling. No statistically significant association existed between management scores and aspirin upon arrival. Conclusions: Higher management scores, as assessed by a novel, in-depth survey, are associated with several MI process of care measures and lower 30-day mortality. Further investigation into these management practices may identify methods for improving MI quality of care. Process and Outcome of MI Care and Management Practices MI Process and Outcome Measure No. of Hospitals Mean Management Score Management Score of Hospitals with Process of Care Performance <25th Percentile Management Score in Hospitals with Process of Care Performance >25th Percentile P-value ASA at arrival 619 3.13 3.08 3.19 0.12 ASA at discharge 614 3.12 3.04 3.21 <0.001 ACEI at discharge 249 3.2 3.09 3.3 0.003 Smoking Cessation Counseling 448 3.16 3.12 3.18 0.07 BB at discharge 616 3.13 3.04 3.18 0.001 PCI <90 minutes in STEMI patients 169 3.17 3.11 3.3 0.009 30-day mortality above the U.S. national average 49 3.35 0.001 30-day mortality at the U.S. national average 602 3.11 30-day mortality below the U.S. national average 8 2.88