Active Physician Management Position As a Structural Feature to Influence Hospital Outcomes: Effect of an Explicit Physician Director Role in a Longterm Acute Care Unit

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97569

Background:

Structural measures of hospital quality describe the characteristics of resources, including people, geographic locations, information technology, organizations, and systems of care. Accountable day–to–day management of inpatient unit process and performance represents a potential opportunity to improve unit outcomes. In an 18–bed long–term acute care unit, we created a physician unit medical director position with an explicit job description including outcomes expectations, a compensation plan aligned with performance expectations, and direct administrative influence on unit budget. Selection of the unit medical director was coordinated with nursing leadership and the medical director was provided leadership coaching by a physician executive.

Methods:

We conducted a time series analysis comparing infection rates and patient satisfaction in the 14 months prior to the new physician medical director position with the first 10 months afterward. For hospital–acquired infection outcomes, the number of events per 1,000 patient or device days was compared to the baseline by poisson regression. Because outcome data is in rates (per 1,000 patient or device days) rather than events, the natural log of the denominator was used as an offset variable in the calculation of significance (Table 1). For patient satisfaction outcomes, contingency tables were created looking at months with a score of >90 in the category “Overall clinical care given” on Press Ganey surveys. Because expected cell numbers were <5 in two of the cells a Fisher exact test was used instead of a Chi–square test. Statistics were performed using SPSS version 17 (Table 2).

Results:

The rate of CAUTIs was reduced by 57% (p < 0.05). Reductions were also observed in rates of VAP (44%) CLABSI (47%), PNA (24%), and Cdiff (47%) but were not statistically significant. The proportion of months with mean patient satisfaction scores above 90 increased from 33 to 82% (p = 0.065).

Conclusions:

Over a 10–month period, a unit–specific physician medical director position was associated with significant reductions in CAUTI, with a trend toward important reductions in CLABSI and Cdiff infections, as well increases in patient satisfaction scores. Reductions in VAP were offset by increases in tracheobronchitis, likely reflecting a stricter definition of VAP. Key factors considered important to the success of the new physician position were an appropriately explicit job description including outcomes expectations, compensation aligned with performance expectations, an expectation to engage as an equal management partner with nursing, and leadership coaching.

Table 1Infection Rates

Cases per 1,000 patient or device days September 8–October 9 November 9–August 10 p value
VAP/1,000 ventilator days 5.56 3.12 0.322
CLABSI/1,000 patient days 2.82 1.50 0.15
CAUTI/1,000 foley days 6.98 3.03 0.035
PNA/1,000 patient days 1.13 0.86 0.655
Tracheobronchitis/1,000 patient days 2.96 5.16 0.065
Cdiff/1,000 patient days 2.82 1.50 0.151
Abbreviations: VAP, ventilator associated pneumonia; CLABSI, central line associated blood stream infection; CAUTI, catheter associated urinary tract infection; Cdiff, clostridium difficile infection; PNA, pneumonia.    

Table 2

Patient Satisfaction September 8–October 9 November 9–October 10 Two–sided p value
Percent months with satisfaction scores >90% 33% 82% 0.065

To cite this abstract:

Wang A, Gartland B, Tong D, Stein J. Active Physician Management Position As a Structural Feature to Influence Hospital Outcomes: Effect of an Explicit Physician Director Role in a Longterm Acute Care Unit. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97569. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/active-physician-management-position-as-a-structural-feature-to-influence-hospital-outcomes-effect-of-an-explicit-physician-director-role-in-a-longterm-acute-care-unit/. Accessed May 23, 2019.

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