Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey

BMC Cardiovascular Disorders

Research Article

Heather Sipsma¹  Amanda L Brewster¹  Leslie Curry²  Elizabeth H Bradley²  Harlan M Krumholz³ 

[1] Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, 60 College Street, 06520-8034, New Haven, CT, USA;Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, 60 College Street, 06520-8034, New Haven, CT, USA;Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, 60 College Street, 06520-8034, New Haven, CT, USA;Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA;Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA;

关键词: Hospitals;    Management;    Quality improvement;    Acute myocardial infarction;   

DOI  :  10.1186/1471-2261-14-126

 received in 2014-07-31, accepted in 2014-09-17,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundSurvival rates after acute myocardial infarction (AMI) vary markedly across U.S. hospitals. Although substantial efforts have been made to improve hospital performance, we lack contemporary evidence about changes in hospital strategies and features of organizational culture that might contribute to reducing hospital AMI mortality rates. We sought to describe current use of several strategies and features of organizational culture linked to AMI mortality in a national sample of hospitals and examine changes in use between 2010 and 2013.MethodsWe conducted a cross-sectional survey of 543 hospitals (70% response rate) in 2013, and longitudinal analysis of a subsample of 107 hospitals that had responded to a survey in 2010 (67% response rate).ResultsBetween 2010 and 2013, the use of many strategies increased, but the use of only two strategies increased significantly: the percentage of hospitals providing regular training to Emergency Medical Service (EMS) providers about AMI care increased from 36% to 71% (P-value < 0.001) and the percentage of hospitals using computerized assisted physician order entry more than doubled (P-value < 0.001). Most, but not all, hospitals reported having environments conducive to communication, coordination and problem solving.ConclusionsWe found few significant changes between 2010 and 2013 in hospital strategies or in key features of organizational culture that have been associated with lower AMI mortality rates. Findings highlight several opportunities to help close remaining performance gaps in AMI mortality among hospitals.

【 授权许可】

CC BY   
© Bradley et al.; licensee BioMed Central Ltd. 2014