Abstract 3197: Hospital Financial Health And Variation In Rates Of IV tPA Adherence In Ma
Introduction: Stroke is the 3rd leading cause of death and in MA over 17,000 residents are hospitalized annually for stroke. At 58/69 MA hospitals, The Paul Coverdell National Acute Stroke Registry (PCNASR) has been collecting detailed information about stroke care since 2005. Acute stroke therapy and IV thrombolysis can be resource intensive. We sought to determine if measures of hospital financial health would explain any of the observed variability in IV tPA adherence in MA
Methods: Hospital PCNASR performance measure data and publicly available financial performance data (www.mass.gov) were linked for 58 participating hospitals for FY 2006-2009. Hospitals with missing financial information (n=3), joined the Registry after 2009 (n=3) and those with <20 annual stroke admissions (n=2) were excluded, leaving 50 hospitals in the analysis. Association of 4 yr average adherence rates for the PCNASR IV tPA measure with 5 traditional hospital characteristics (teaching status, urban/rural designation, stroke volume, geographic region, years of participation in the MA stroke QI collaborative) and 4 financial variables (total margin, operating margin, cash flow to total debt ratio, and cash on hand) were assessed in univariate analyses. All variables significant at p< .10 were tested in a multivariable regression model.
Results: There were 50 hospitals analyzed over 4 years with median bed size 194 [IQR 126,292], median stroke admissions 219 [IQR 94,365] and 20% teaching hospitals. Among the 4 candidate financial variables significant in univariate analysis, only total margin remained significant (p=.04) after accounting for interaction terms among the 4 variables (Table 1). In multivariate analyses, only total margin remained significant (p=0.04) but it accounts for a negligible amount of variability (r-square 0.08) and increasing financial health was if anything inversely associated with tPA use (Beta Coefficient -0.288).
Conclusions: In our cohort of hospitals representing the majority of tPA administration over 4 years in MA, we found that standard industry measures of hospital financial health or other traditional hospital level factors did not explain the variability in rates of thrombolysis use. These findings suggest that changes in financial health at the global hospital level should not be perceived as a barrier to successful stroke thrombolysis program development at the local level.
- © 2012 by American Heart Association, Inc.