Hospital-Level Cardiovascular Management Practices in Kerala, India

Abstract

Background: Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results:We measured management practices through a semi-structured, inperson interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events (MACE) defined as all-cause mortality, re-infarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found sub-optimal management practices across three management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [p = 0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality

Hospital Management Practices In County-Level Hospitals In Rural China And International Comparison

“…While we included all public hospitals in the region, we only sampled a minority of private hospitals, so our results are likely less applicable to private hospitals. Lastly, although management quality has been correlated with hospital outcomes in other countries [2,3,14,[31][32][33], it would still be bene cial to examine the link between these factors in the Chinese context.…”

“…Evidence from high-income countries (HICs) has also shown that better hospital management scores are associated with being a high-quality hospital [2]. Data from low-and middle-income country (LMIC) also show that better hospital-level cardiovascular management practices are associated with better clinical outcomes (for major adverse cardiovascular events) [3]. Thus, it is important to accurately assess and try to improve hospital management practices, as they may greatly impact healthcare outcomes.…”

Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

“…Another noticeable fact is the low utilization of the golden hour treatment for any vascular illness, especially for stroke and cardiovascular India and the global burden of disease [30] Health systems of Kerala diseases [5,8,9,22,31]. Studies related to emergency cardiac or stroke treatment in the Kerala population are scarce [8,9,32]. One of the studies concluded that the pre-hospital delay in acute stroke patients is significantly high compared to other communities.…”

“…According to some studies, awareness of the population regarding recognizing symptoms of a cardiac or cerebrovascular illness was contentious [5,8,32]. Patients with more disturbing symptoms such as limb weakness or chest pain arrived at hospital facilities earlier compared with subtle or vague symptoms [5,8,32,34]. Some studies reported the issue of under-reporting of less severe or benign illnesses, especially among the poor [14,35].…”

“…Regarding the prehospital emergency services in the state, some were termed as "not satisfactory" by some studies [9,21,28,41,42]. Additionally, organization-level management nicks play a role in the failure of emergency management in case of vascular ailments [9,32]. Kerala's health system has achieved tremendous success in its primary care strategies; however, their emergency care efficiency is contentious.…”