Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction

Bradley, Elizabeth H.; Curry, Leslie; Spatz, Erica S.; Herrin, Jeph; Cherlin, Emily; Curtis, Jeptha P.; Thompson, Jennifer; Ting, Henry H.; Wang, Yongfei; Krumholz, Harlan M.

doi:10.7326/0003-4819-156-9-201205010-00003

Cited by 115 publications

(104 citation statements)

References 39 publications

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“…Regardless of the patient's level of adherence, it is essential for CF care teams to approach the conversation in a collaborative and empathic manner to maintain a positive therapeutic relationship. For example, the use of patient-centered strategies, such as shared decision making and motivational interviewing, have been shown to be effective in improving adherence in other chronic illnesses and should be study specifically in CF [12,20].…”

Section: Discussionmentioning

confidence: 99%

Opportunities for cystic fibrosis care teams to support treatment adherence

Riekert

Eakin

Bilderback

et al. 2015

Journal of Cystic Fibrosis

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Section: Discussionmentioning

confidence: 99%

Opportunities for cystic fibrosis care teams to support treatment adherence

Riekert

Eakin

Bilderback

et al. 2015

Journal of Cystic Fibrosis

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“…The National Quality Forum 15 approved these measures and an independent committee of statisticians nominated by the Committee of Presidents of the Statistical Societies endorsed the validity of the methods. 16 Risk standardized readmission rates are publically reported by the Centers for Medicare and Medicaid Services [4][5][6][7][8][9] and have been incorporated into incentive programs within the Affordable Care Act. 9 The modeling strategy used for risk standardization accounts for correlation of observed readmission rates within a hospital and reflects the assumption that, after adjustment for sampling variability and patient characteristics including age, sex, and comorbidities, the remaining variation in readmission rates reflects hospital quality.…”

Section: Hospital Performancementioning

confidence: 99%

“…We focused on patients who were initially admitted for heart failure, acute myocardial infarction, or pneumonia as these illnesses are among the most common causes of admission in older people 8 and are the focus of performance based reimbursement by the Centers for Medicare and Medicaid Services. [4][5][6][7][8][9] Methods…”

Section: Introductionmentioning

confidence: 99%

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Dharmarajan

Hsieh

Lin

et al. 2013

BMJ

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Objectives To determine whether high performing hospitals with low 30 day risk standardized readmission rates have a lower proportion of readmissions from specific diagnoses and time periods after admission or instead have a similar distribution of readmission diagnoses and timing to lower performing institutions.Design Retrospective cohort study.Setting Medicare beneficiaries in the United States.Participants Patients aged 65 and older who were readmitted within 30 days after hospital admission for heart failure, acute myocardial infarction, or pneumonia in 2007-09. Main outcome measuresReadmission diagnoses were classified with a modified version of the Centers for Medicare and Medicaid Services' condition categories, and readmission timing was classified by day (0-30) after hospital discharge. Hospital 30 day risk standardized readmission rates over the three years of study were calculated with public reporting methods of the US federal government, and hospitals were categorized with bootstrap analysis as having high, average, or low readmission performance for each index condition. High and low performing hospitals had ≥95% probability of having an interval estimate respectively less than or greater than the national 30 day readmission rate over the three year period of study. All remaining hospitals were considered average performers.Results For readmissions in the 30 days after the index admission, there were 320 003 after 1 291 211 admissions for heart failure (4041 hospitals), 102 536 after 517 827 admissions for acute myocardial infarction (2378 hospitals), and 208 438 after 1 135 932 admissions for pneumonia (4283 hospitals). The distribution of readmissions by diagnosis was similar across categories of hospital performance for all three conditions. High performing hospitals had fewer readmissions for all common diagnoses. Median time to readmission was similar by hospital performance for heart failure and acute myocardial infarction, though was 1.4 days longer among high versus low performing hospitals for pneumonia (P<0.001). Findings were unchanged after adjustment for other hospital characteristics potentially associated with readmission patterns.Conclusions High performing hospitals have proportionately fewer 30 day readmissions without differences in readmission diagnoses and timing, suggesting the possible benefit of strategies that lower risk of readmission globally rather than for specific diagnoses or time periods after hospital stay.

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“…Previous studies have shown that the optimizing of management strategies could improve the quality of medical care and patient satisfaction. [1][2][3][4] In fact, patients' outcomes rely not only on "hard wares" such as medical technologies and clinical skills of medical staff, but also on "soft wares" such as hospital management practices. Existing data have shown that hospitals with high-level medical quality usually have a higher-level of management performance in fields such as goal-setting, medical environment and performance incentives.…”

Section: Introductionmentioning

confidence: 99%

Development and evaluation of a hospital management practice rating scale

Zhu

Guo

Dou

et al. 2018

JHA

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Background: Lacking methods to quantify the inter-hospital variance in hospital management practice (HMP) is a bottle neck for research on HMP and quality of care. This study aims to quantify the inter-hospital variance in HMP by developing a novel rating scale of HMP and evaluating its feasibility, reliability and validity. Methods: Based on the theory of hospital management, we developed a HMP rating scale with 4 dimensions: Target, operations, performance and talent management. We used questionnaires to collect relevant information from the hospital director, the medical affairs director, the head of the department of cardiology, and a cardiologist. And we also requested a list of administration documents. For validation of the scale, we applied it to 101 hospitals that had participated in the Third Phase of the Clinical Pathways in Acute Coronary Syndromes Study (CPACS-3) in 2013 and repeated it in 2014. Results: The HMP rating scale includes 17 indicators and 47 sub-indicators in the four dimensions; 85% and 97% of hospitals responded to the first and second survey respectively. A high degree of the test-retest reliability for the overall score (ICC = 0.8) was found between the two time points. Both split-half and Cronbach'α coefficient of the overall score exceeded 0.85. Cumulative percentage of variance in all dimensions was above 60%, and factors extracted in each dimension were highly consistent with the designed indicators and sub-indicators. The overall HMP score was different between hospital groups with different revenues, patients' hospital stays, and number of clinical pathways (All p values < .01). Conclusions:The HMP rating scale was demonstrated reliable, valid, and responsive, but future studies with larger sample size in different settings are needed to confirm the study findings.

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Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction

Abstract: Background-Despite recent improvements in survival after acute myocardial infarction (AMI), U.S. hospitals vary 2-fold in their 30-day risk-standardized mortality rates (RSMRs). Nevertheless, information is limited on hospital-level factors that may be associated with RSMRs.

Cited by 115 publications

References 39 publications

Opportunities for cystic fibrosis care teams to support treatment adherence

Opportunities for cystic fibrosis care teams to support treatment adherence

Hospital readmission performance and patterns of readmission: retrospective cohort study of Medicare admissions

Development and evaluation of a hospital management practice rating scale

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