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Original Investigation
Health Care Reform
April 22, 2013

Management Practices and the Quality of Care in Cardiac Units

Author Affiliations

Author Affiliations: Center for Health Systems Effectiveness and Department of Emergency Medicine, Oregon Health & Science University, Portland (Dr McConnell); Department of Health Systems, Management & Policy, University of Colorado, Aurora (Dr Lindrooth); Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis (Dr Wholey); Department of Cardiology, Veterans Affairs Eastern Colorado Health Care System/University of Colorado School of Medicine, Denver (Dr Maddox); and Department of Economics, Stanford University, Stanford, California (Dr Bloom).

JAMA Intern Med. 2013;173(8):684-692. doi:10.1001/jamainternmed.2013.3577

Importance To improve the quality of health care, many researchers have suggested that health care institutions adopt management approaches that have been successful in the manufacturing and technology sectors. However, relatively little information exists about how these practices are disseminated in hospitals and whether they are associated with better performance.

Objectives To describe the variation in management practices among a large sample of hospital cardiac care units; assess association of these practices with processes of care, readmissions, and mortality for patients with acute myocardial infarction (AMI); and suggest specific directions for the testing and dissemination of health care management approaches.

Design We adapted an approach used to measure management and organizational practices in manufacturing to collect management data on cardiac units. We scored performance in 18 practices using the following 4 dimensions: standardizing care, tracking of key performance indicators, setting targets, and incentivizing employees. We used multivariate analyses to assess the relationship of management practices with process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for acute myocardial infarction (AMI).

Setting Cardiac units in US hospitals.

Participants Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges.

Main Outcome Measures Process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for AMI.

Results We found a wide distribution in management practices, with fewer than 20% of hospitals scoring a 4 or a 5 (best practice) on more than 9 measures. In multivariate analyses, management practices were significantly correlated with mortality (P = .01) and 6 of 6 process measures (P < .05). No statistically significant association was found between management and 30-day readmissions.

Conclusions and Relevance The use of management practices adopted from manufacturing sectors is associated with higher process-of-care measures and lower 30-day AMI mortality. Given the wide differences in management practices across hospitals, dissemination of these practices may be beneficial in achieving high-quality outcomes.