title: Management practices and the quality of care in cardiac units.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  Cardiac units in US hospitals.
  
  
  METHODS
  Five hundred ninety-seven cardiac units, representing 51.5% of hospitals with interventional cardiac catheterization laboratories and at least 25 annual AMI discharges.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Emergency Medicine, Oregon Health & Science University, Portland, OR97239, USA. mcconnjo@ohsu.edu
authors.forename: K John
authors.initials: KJ
authors.lastname: McConnell
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Wholey
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.forename: Nick
authors.initials: N
authors.lastname: Bloom
mesh_terms: D002300:Cardiac Care Facilities / Q000458:organization & administration / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010359:Patient Readmission; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000592:standards*