Hospital Strategies for Improving Hospital Outcomes for Patients with Acute Myocardial Infarction
In 2007, we received a competitive R01 grant from the Agency for Healthcare Research and Quality to conduct a study that defined how hospital strategies may improve outcome performance following acute myocardial infarction (AMI). From our previous research, we found that although hospital performance on core AMI process measures is associated with hospital variation in risk-adjusted 30-day mortality rates for patients with AMI, the correlation was modest, leaving the vast majority of variation unexplained. The purpose of our study was to identify key hospital features that were strongly associated with risk-adjusted short-term mortality rates for patients with acute myocardial infarction. We examined features related to hospital structure, specific processes undertaken by the hospital, and the organizational environment of the hospital, such as communication and coordination among groups.
Utilizing a robust mixed-methods approach, we:
- Generated hypotheses regarding which hospital-based organizational efforts may have been associated with hospital risk-adjusted 30-day mortality rates for patients with AMI
- Tested these hypotheses in a national sample of hospitals
This was accomplished in two phases. First, we conducted in-depth qualitative interviews and site visits with 158 staff in 11 hospitals, including top and bottom performing hospitals based on risk-standardized 30-day mortality rates published by Centers for Medicare & Medicaid Services (CMS). Second, based on hypotheses generated by the qualitative study, we designed and implemented a web-based survey that was used to determine the associations between the identified hospital efforts and hospital risk-adjusted 30-day mortality rates for Medicare fee-for-service patients.
Our goal now is to collaborate with leading organizations to promote the national dissemination of our findings to improve hospital care for patients with AMI.