Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: - - PowerPoint PPT Presentation

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Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: - - PowerPoint PPT Presentation

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Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation Academy Health Annual Research Meeting Orlando, FL June 24, 2012 Derek DeLia, Ph.D. a ; Henry Wang, MD, MS b ; Jared Kutzin, DNP, MPH,

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Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation

Derek DeLia, Ph.D.a; Henry Wang, MD, MSb; Jared Kutzin, DNP, MPH, RN, EMTc; Mark Merlin, DO, EMT-P, FACEPd; Joel C. Cantor, Sc.D.a

aRutgers Center for State Health Policy bUniversity of Alabama-Birmingham: Dept of Emergency Medicine

  • cSt. Barnabas Medical Center, UMDNJ, Englewood Hospital & Medical Center

dNewark Beth Israel Medical Center

Academy Health Annual Research Meeting Orlando, FL June 24, 2012

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Center for State Health Policy 2

Acknowledgements

This research was supported by the Agency for Healthcare Research & Quality (Grant no. R01-HS020097-01) Assistance from Manisha Agrawal, Nicole DeMola, and Ayesha Aslam

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Center for State Health Policy 3

Therapeutic hypothermia (TH)

  • Fairly new & innovative treatment for out-of-hospital cardiac

arrest (OHCA)

– Reduce body temperature during post-arrest treatment – Improve survival & neurological outcomes

  • TH now recommended treatment for OHCA

– International Liaison Committee on Resuscitation, 2005 – American Heart Association, 2010

  • But TH is not universally used

– Difficult to set up & maintain TH capability – Doubts about (limited) evidence base

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Center for State Health Policy 4

Our project (overall)

Aim 1: Create linked database for NJ

Prehospital EMS (EHRs)  Hospital billing records  Mortality records

Aim 2: Conduct CER study of TH vs. non-TH OHCA care

  • Coding of TH in hospital billing records

– ICD-9-CM code exists – No reimbursement consequences – Likely under/no reporting

  • We conducted a survey of TH use by NJ hospitals
  • Today’s presentation reports on survey results
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Center for State Health Policy 5

Survey of NJ hospitals

  • Fielded in Summer 2011
  • Brief telephone survey (5-10 minutes)

– ED nurse manager (or similar position) – TH use, protocols, related issues – Written protocols if available

  • Fallback: 90-second version
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Center for State Health Policy 6

Participation

  • Universe = 73 acute care hospitals
  • 54 full interviews
  • 19 brief (fallback) interviews
  • 18 written protocols

(21 hospitals)

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Center for State Health Policy

NJ hospitals providing TH, Summer 2011

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68.4% 13.7% 17.8% Currently providing TH Plan to provide TH Not providing TH & no plans Based on 73 acute care hospitals in all NJ hospitals

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Center for State Health Policy

Growth in # NJ hospitals providing TH

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1 2 4 7 24 38

47*

2004 2005 2006 2007 2008 2009 2010 2011 * 3 additional hospitals provided TH in 2011 but could not report how long the TH program had been in place. Therefore, 2011 total is 50.

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Center for State Health Policy

TH provision by annual OHCA volume

0% 10% 20% 30% 40% 50% 60% 70% ≤ 12 13-36 37-60 61-120 ≥ 121 Providing TH Plan to provide Not providing

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Based on 54 hospitals w/full survey data. Percentages sum to 100 within colored bars.

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Center for State Health Policy

TH provision & other hospital characteristics

  • Little or no difference by …

– Teaching status – Patient volume – Occupancy rate

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Center for State Health Policy

Exclusion criteria: Patient characteristics

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81.6% 71.8% 71.1% 68.4% 55.6% 50.0% 44.7% 41.7% 62.2% 17.9% of TH hospitals exclude based on all 8 conditions asked. Based on 39 TH hospitals w/full survey data.

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Center for State Health Policy

Inclusion criteria: ECG rhythms

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91.9% 89.2% 71.1% 65.8% VT VF PEA Asystole 51.3% of TH hospitals provide TH for all 4 rhythms. Based on 39 TH hospitals w/full survey data.

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Center for State Health Policy

Cooling methods

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80.0% 74.4% 59.0% 51.3% 28.9% 2.6%

Specialized systems I/V fluids Cold packs Blankets Endovascular catheter Others

35.9% of TH hospitals coordinate cooling w/prehospital EMS. Based on 39 TH hospitals w/full survey data.

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Center for State Health Policy

Written protocols

  • Large variation in …

– Duration of TH – Defined start of duration time – Time to reach target temperature – Re-warming time – Measurement & response to patient shivering

  • Large variation in protocol details

– Level of detail – What gets mentioned

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Center for State Health Policy

Summary

  • Most NJ hospitals implementing TH guidelines
  • Large variation in the way guidelines are implemented
  • TH centers often see very low volume of OHCA patients

– TH volume even smaller given patient exclusions

  • > 1/3 of TH centers coordinate patient cooling in

prehospital setting

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Center for State Health Policy

Implications

  • Variation in TH practice

– Does it affect patient outcomes? – What does it mean to follow practice guidelines?

  • Patient selection criteria ==> access disparities?
  • Low TH volume & quality of care

– Prior research ==> better outcomes if annual OHCA cases ≥ 40

  • Factors that determine adoption of TH guidelines not

well understood

– Reputation/marketing, peer influence?

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Center for State Health Policy

For more information …

  • D. DeLia, H. Wang, J. Kutzin, M. Merlin, & J.C. Cantor

(2012), “Post Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation.” Forthcoming in Therapeutic Hypothermia and Temperature Management.

  • D. DeLia: ddelia@ifh.rutgers.edu

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