Examination of the influences of hospital context on outcomes for patients undergoing cardiac catheterization procedures

Abstract

Despite the time and resources focused on health care outcomes, few empirical links exist between healthcare activities, healthcare costs and outcomes of care. As a result, outcome evaluations that take into account the characteristics of the healthcare system as well as the desires of a number of stakeholders may have relevance to knowledge development as well as to implementation of needed changes in health care delivery. Using the framework of General Systems Theory (von Bertalanffy, 1968) and a modification of the model proposed by the American Academy of Nursing Expert Panel (Mitchell, Ferketich, Jennings, 1998), this investigation addressed broad categories of outcomes, including clinical and financial aspects, and examined the factors influencing them in a condition-specific population. Further, the contextual characteristics of the healthcare organization and the work group were examined and compared to the effects of the individual patient characteristics on cost, length of stay and morbidity/mortality outcomes. Organizational factors included structural characteristics such as volume and technology availability, work unit factors included perceived collaboration, access to power structures and control over nursing practice and individual patient factors included pre-hospital health conditions and socio-economic status. For this study outcomes consisted of adverse events, derived length of stay and direct costs. This study used a non-experimental, descriptive design. Contextual regression analysis indicated that organizational structure variables had a greater influence on cost and the work group-level variables had a greater influence on derived length of stay than did the individual-level variables. Total average costs for cardiac catheterization procedure and associated post-procedure hospitalization were 3758 (range 777-12,796). While the study has several limitations, the findings add to the body of knowledge that explains how the processes of nurses' work influence the outcomes of that work. The findings deserve consideration by nurse executives and others interested in enhancing work environments and patient care outcomes.