title: Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction.
abstract: BACKGROUND
  Despite recent improvements in survival after acute myocardial infarction (AMI), U.S. hospitals vary 2-fold in their 30-day risk-standardized mortality rates (RSMRs). Nevertheless, information is limited on hospital-level factors that may be associated with RSMRs.
  
  
  OBJECTIVE
  To identify hospital strategies that were associated with lower RSMRs.
  
  
  METHODS
  Cross-sectional survey of 537 hospitals (91% response rate) and weighted multivariate regression by using data from the Centers for Medicare & Medicaid Services to determine the associations between hospital strategies and hospital RSMRs.
  
  
  METHODS
  Acute care hospitals with an annualized AMI volume of at least 25 patients.
  
  
  METHODS
  Patients hospitalized with AMI between 1 January 2008 and 31 December 2009.
  
  
  METHODS
  Hospital performance improvement strategies, characteristics, and 30-day RSMRs.
  
  
  RESULTS
  In multivariate analysis, several hospital strategies were significantly associated with lower RSMRs and in aggregate were associated with clinically important differences in RSMRs. These strategies included holding monthly meetings to review AMI cases between hospital clinicians and staff who transported patients to the hospital (RSMR lower by 0.70 percentage points), having cardiologists always on site (lower by 0.54 percentage points), fostering an organizational environment in which clinicians are encouraged to solve problems creatively (lower by 0.84 percentage points), not cross-training nurses from intensive care units for the cardiac catheterization laboratory (lower by 0.44 percentage points), and having physician and nurse champions rather than nurse champions alone (lower by 0.88 percentage points). Fewer than 10% of hospitals reported using at least 4 of these 5 strategies.
  
  
  CONCLUSIONS
  The cross-sectional design demonstrates statistical associations but cannot establish causal relationships.
  
  
  CONCLUSIONS
  Several strategies, which are currently implemented by relatively few hospitals, are associated with significantly lower 30-day RSMRs for patients with AMI.
  
  
  BACKGROUND
  The Agency for Healthcare Research and Quality, the United Health Foundation, and the Commonwealth Fund.
authors.affiliation: Yale School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA. elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Thompson
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D020407:Internet; D008505:Medical Staff, Hospital / Q000458:organization & administration; D009203:Myocardial Infarction / Q000401:mortality*; D015279:Organizational Culture; D010348:Patient Care Team; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012044:Regression Analysis; D014481:United States