Simon-Michael-Leuven.. - The European Academy of Nursing Science

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Simon-Michael-Leuven.. - The European Academy of Nursing Science

Patient satisfaction and mortality in ANCC

Magnet hospitals

Michael Simon

The EANS Summer Conference 2012, Leuven, Belgium


Background


History of Magnet

1981 AAN taskforce to investigate organizations

maintaining a experienced and trained

nursing workforce

1990’s Magnet Recognition Program by ANA

1998 Extension to LTC

2000 International

2007 Pathway to Excellence Program

2008 Revision of Magnet Model

3


Forces of Magnetism

Quality of Nursing Leadership

Consultation & Resources

Organizational Structure

Management Style

Personnel Policies & Programs

Autonomy

Community & Health Care

Organization

Nurses as Teachers

Professional Models of Care

Image of Nursing

Quality of Care

Interdisciplinary Relationships

Quality Improvement

Professional Development

4


Magnet Model (2008)

• Structural Empowerment

• Exemplary Professional Practice

• New Knowledge, Innovations, and Improvements

• Transformational Leadership

• Empirical Outcomes

5


Magnet Designation today

• ANCC Magnet Recognition Program® “recognizes

healthcare organizations for quality patient care,

nursing excellence and innovations in professional

nursing practice”

• Recognised Magnet facilities in USA (388), AUS (3),

SGP (1), LBN (1)

• 8 out of the 10 Best Hospitals

of US News Report

• ~7% of all US hospitals

6


Is there a difference between Magnet

recognised hospitals in comparison to nonrecognised

peers with regard to…

…patient experience

…mortality

7


Methods


Approach

• Secondary analysis of public data

• Hospital level

• Case-control design

• Genetic propensity score matching

9


What is genetic propensity score

matching

• Uses logistic regression to calculate propensity scores

-> conditional probability to be “treated”

• Propensity scores are used to match cases & controls

• Genetic matching uses propensity score and

Mahalanobis distance matching to optimize covariate

balance in the treatment and control group

10


Data sources

• Hospital Compare

– Patient Satisfaction (HCAHPS)

– Mortality Rates

• AHA Annual Survey

• Centers for Medicare & Medicaid Services (CMS)

• ANCC website

11


Outcomes: Patient Satisfaction

• “Hospital Consumer Assessment of Healthcare

Providers and Systems Survey” (HCAHPS)

• Random sample from discharged patients

• Medical, surgical, maternal care

• Results are mode and patient mix adjusted

• General Patient Satisfaction:

– Rate the hospital overall % patients rating 9 or 10

– Would patients recommend the hospital to friends

and family % patients recommending hospital

12


Outcomes: 30-Day Mortality

• Acute Myocardial Infarction (AMI) 30-Day Mortality

Rate

• Heart Failure (HF) 30-Day Mortality Rate

• Pneumonia (PN) 30-Day Mortality Rate

– FFS Medicare Beneficiaries

– Age >65

– Risk adjusted for age, cardiovascular history and

comorbidities

13


Control variables

• Supplemental Security Income Ratio (CMS)

– SSI inpatient days/All inpatient days

• Case Mix Index (CMI)

• Census Division (AHA)

– USA split in 9 regions

• Bed size category (AHA)

• Ownership status (AHA)

• Teaching status (AHA)

14


1 st Magnet recognition per year

60

40

Freq

20

0

1995 2000 2005

15


Used data & time

16


Results


Ownership status (merged sample, N=2,351)

Non-Magnet

Magnet

For profit 18% (385) 1% (3)

Gov. non-fed 12% (257) 8% (17)

Not for profit 70% (1490) 91% (199)

18


Bed Size (merged sample, N=2,351)

Non-Magnet

Magnet

500+ 12% (263) 39% (86)

400-499 8% (171) 14% (31)

300-399 14% (290) 17% (37)

200-299 22% (475) 15% (32)

100-199 33% (693) 13% (28)

50-99 11% (240) 2% (5)

19


Patient Population (merged sample, N=2,351)

Non-Magnet

Magnet

SSI rate 0.088 0.065

Case-Mix 1.492 1.661

20


What is balance

Bed size

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Magnet Non-Magnet

50-99

100-199

200-299

300-399

400-499

500+

21


What is balance

Bed size

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

Magnet Non-Magnet

50-99

100-199

200-299

300-399

400-499

500+

22


How to assess Balance

Standardized Mean Difference (d):

100 ∗

• Sample size independent


Balance: Stand. Mean Difference

(n=2,351)

Before

After

(n=438)

24

160

150

140

130

120

110

100

90

80

70

60

50

40

30

20

10

0

SSI Ratio

CMI

SouthAtlantic

Pacific

Mountain

ENCentral

WNCentral

ESCentral

WSCentral

NewEngland

MidAtlantic

Not for profit

Gov non fed

For profit

500+

400-499

300-399

200-299

100-199

50-99

CGME

AMA

NLN

COTH


Patient Satisfaction:

Item ATE P

Highest Rating hospital 2.34 0.001

Recommend hospital 2.90 0.001

Highest Rating: 54% of the way from mean to 75%-percentile

Recommend: 62% of the way from mean to 75%-percentile

25


Mortality:

Item ATE P

30-day MI -0.148 0.42

30-day HF -0.200 0.22

30-day PN -0.061 0.77

26


Discussion


Summary

• Magnets are larger, not-for-profit

organizations, with less disabled but sicker

patients

• Patients are more satisfied in Magnets

• No significant differences for mortality

(although Magnets seem to have lower rates)

28


Conclusions & Outlook

• First study examining magnet status & patient

satisfaction

• Next Steps:

– Imputation

– SE inflated (= type II error)

– Extension to more pat satisfaction domains

29


Thanks!

Contact me:

m.simon@soton.ac.uk

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