Department of Emergency Medicine, Oregon Health & Science University, Portland, OR97239, USA.
JAMA Intern Med. 2013 Apr 22;173(8):684-92. doi: 10.1001/jamainternmed.2013.3577.
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.
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.
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).
Cardiac units in US hospitals.
Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges.
Process-of-care measures, 30-day risk-adjusted mortality, and 30-day readmissions for AMI.
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.
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.
为了提高医疗质量，许多研究人员建议医疗机构采用制造业和科技领域成功的管理方法。然而，关于这些实践在医院中的传播情况以及它们是否与更好的绩效相关，相对较少的信息。
描述大量医院心脏护理单元的管理实践的变化;评估这些实践与急性心肌梗死 (AMI) 患者的护理过程、再入院和死亡率之间的关联;并为医疗保健管理方法的测试和传播提出具体方向。
我们采用了一种用于测量制造业管理和组织实践的方法，来收集心脏科病房的管理数据。我们使用以下 4 个维度来衡量 18 项管理实践的绩效：标准化护理、关键绩效指标的跟踪、设定目标和激励员工。我们使用多变量分析来评估管理实践与护理过程措施、30 天风险调整死亡率和 30 天 AMI 再入院率之间的关系。
美国医院的心脏科病房。
597 个心脏科病房，代表了至少有 25 名年度 AMI 出院病人的、具有介入性心脏导管实验室的医院的 51.5%。
护理过程措施、30 天风险调整死亡率和 30 天 AMI 再入院率。
我们发现管理实践的分布范围很广，只有不到 20%的医院在 9 项以上措施上的得分达到 4 或 5 分（最佳实践）。在多变量分析中，管理实践与死亡率（P =.01）和 6 项护理过程措施中的 6 项（P <.05）显著相关。管理实践与 30 天再入院率之间没有统计学上的显著关联。
采用制造业部门采用的管理实践与更高的护理过程措施和更低的 30 天 AMI 死亡率相关。鉴于医院之间管理实践的差异很大，传播这些实践可能有助于实现高质量的结果。
