Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

Objective We hypothesized that perioperative hospital resources could overcome the “weekend effect” (WE) in patients undergoing emergent/urgent surgeries. Summary Background Data The WE is the observation that surgeon-independent patient outcomes are worse on the weekend compared with weekdays. The WE is often explained by differences in staffing and resources resulting in variation in care between the week and weekend. Methods Emergent/urgent surgeries were identified using the Healthcare Cost and Utilization Project State Inpatient Database (Florida) from 2007 to 2011 and linked to the American Hospital Association (AHA) Annual Survey Database to determine hospital level characteristics. Extended median length of stay (LOS) on the weekend compared with the weekdays (after controlling for hospital, year, and procedure type) was selected as a surrogate for WE. Results Included were 126,666 patients at 166 hospitals. A total of 17 hospitals overcame the WE during the study period. Logistic regression, controlling for patient characteristics, identified full adoption of electronic medical records (OR 4.74), home health program (OR 2.37), pain management program [odds ratio (OR) 1.48)], increased registered nurse-to-bed ratio (OR 1.44), and inpatient physical rehabilitation (OR 1.03) as resources that were predictors for overcoming the WE. The prevalence of these factors in hospitals exhibiting the WE for all 5 years of the study period were compared with those hospitals that overcame the WE (P <0.001). Conclusions Specific hospital resources can overcome the WE seen in urgent general surgery procedures. Improved hospital perioperative infrastructure represents an important target for overcoming disparities in surgical care.

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“…More in-depth investigation of hospital attributes (e.g., qualitative assessment of institutional policies and protocols regarding patient selection for revascularization procedures and ICU admissions at hospitals in different phenotypes) will further inform the underlying reasons for the variation (28). Moreover, some factors that influence practice patterns may be at the physician level, calling for more research on physician-hospital dynamics (e.g., engagement of physicians by hospitals in quality, safety, and cost containment initiatives) (29, 30). …”

Section: Discussionmentioning

confidence: 99%

Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction

Lin

et al. 2016

Medical Care

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Objectives To characterize hospital phenotypes by their combined utilization pattern of percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG) procedures, and intensive care unit (ICU) admissions for patients hospitalized for acute myocardial infarction (AMI). Research Design Using the Premier Analytical Database, we identified 129,138 hospitalizations for AMI from 246 hospitals with the capacity for performing open-heart surgery during 2010-2013. We calculated year-specific, risk-standardized estimates of PCI procedure rates, CABG procedure rates, and ICU admission rates for each hospital, adjusting for patient clinical characteristics and within-hospital correlation of patients. We used a mixture modeling approach to identify groups of hospitals (i.e., hospital phenotypes) that exhibit distinct longitudinal patterns of risk-standardized PCI, CABG, and ICU admission rates. Results We identified 3 distinct phenotypes among the 246 hospitals: 1) high PCI - low CABG - high ICU admission (39.2% of the hospitals), 2) high PCI - low CABG - low ICU admission (30.5%), and 3) low PCI - high CABG - moderate ICU admission (30.4%). Hospitals in the high PCI - low CABG - high ICU admission phenotype had significantly higher risk-standardized in-hospital costs and 30-day risk-standardized payment yet similar risk-standardized mortality and readmission rates compared with hospitals in the low PCI - high CABG - moderate ICU admission phenotype. Hospitals in these phenotypes differed by geographic region. Conclusions Hospitals differ in how they manage patients hospitalized for AMI. Their distinctive practice patterns suggest that some hospital phenotypes may be more successful in producing good outcomes at lower cost.

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Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings

Cited by 56 publications

References 28 publications

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Components of Hospital Perioperative Infrastructure Can Overcome the Weekend Effect in Urgent General Surgery Procedures

Hospital Phenotypes in the Management of Patients Admitted for Acute Myocardial Infarction

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