title: Strategies to reduce hospital 30-day risk-standardized mortality rates for patients with acute myocardial infarction: a cross-sectional and longitudinal survey.
abstract: BACKGROUND
  Survival 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.
  
  
  METHODS
  We 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).
  
  
  RESULTS
  Between 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.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Health Policy and Management, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA. elizabeth.bradley@yale.edu.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Heather
authors.initials: H
authors.lastname: Sipsma
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Brewster
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
mesh_terms: D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000458:organization & administration; D004634:Emergency Medical Technicians / Q000193:education / Q000458:organization & administration; D019538:Health Care Surveys; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D033183:Interdisciplinary Communication; D008137:Longitudinal Studies; D050316:Medical Order Entry Systems / Q000458:organization & administration; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D013997:Time Factors; D014481:United States