Elizabeth H. Bradley, Heather Sipsma, Amanda L. Brewster, Harlan M. Krumholz, and Leslie Curry
E. H. Bradley, H. Sipsma, A. L. Brewster et al., “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, published online Sept. 24, 2014.
More than 800,000 people in the United States are hospitalized each year with acute myocardial infarction (AMI), or heart attack, with marked differences in survival rates seen across the country. This Commonwealth Fund–supported study looked at which strategies hospitals are using to reduce AMI deaths.
By 2013, the vast majority of hospitals had quality improvement teams devoted to lowering inpatient mortality, had assigned a group or person to review AMI deaths that occurred during hospitalization, and had joined regional efforts to improve AMI care. Fewer than half had a team focused on postdischarge deaths, or a review process for deaths within 30 days of admission.
From 2010 to 2013, hospitals’ use of many strategies increased, but use rose significantly for only these three: a quality improvement team devoted to reducing postdischarge mortality (24% in 2010 to 44% in 2013); training for emergency medical workers (36% to 61%); and computerized physician order entry (33% to 83%).
While the study found an overall trend toward greater adoption of these strategies, most changes were modest in size. The authors note that several strategies are complex interventions that require coordination among units, like having clinicians meet with EMS providers monthly, or substantial investment, like having a cardiologist on site at all times.