Hospital strategies to improve outcome performance

Summary

Principal Investigator: Bradley H Elizabeth
Affiliation: Yale University
Country: USA
Abstract: DESCRIPTION (PROVIDED BY APPLICANT): Despite a decade of efforts to improve care for patients with acute myocardial infarction (AMI) there remains substantial variation across hospitals in patient mortality rates after AMI. The risk-adjusted 30 day mortality rates of hospitals in 2003 ranged from 11% to 23%, more than a two-fold difference. Although patient survival is a fundamental goal of the hospitalization, we know little about what distinguishes hospitals with lower risk-adjusted short-term mortality rates. A substantial body of health care organizational theory posits that hospital structures, processes, and internal environments may influence hospital operational and financial outcomes; however, we have less empirical evidence concerning their influence on clinical outcomes; such as risk-adjusted mortality rates, especially among patients with AMI. We will use a mixed methods approach to: 1) generate hypotheses regarding hospital-specific efforts (characterized as enabling structures, processes of care, and hospital internal environments) that may be associated with hospital risk-adjusted 30 day mortality rates for patients with AMI; and 2) determine the hospital effort that are statistically associated with hospital risk-adjusted 30 day mortality rates for patients with AMI. This methodology employs qualitative and quantitative research in a complementary fashion to generate and then to test hypotheses. We employ a validated, risk-adjusted mortality model and hierarchical generalized linear models to examine hospital-level variation in risk-adjusted mortality. This risk-adjustment model has been endorsed by the National Quality Forum and slated for use by the Centers for Medicare & Medicaid Services (CMS) as a publicly reported quality indicator in 2007. The lack of evidence about what accounts for hospital-level variation in risk -adjusted mortality rates is a critical gap in our current knowledge about how to improve outcomes. The proposed study will provide the foundation for evidence-based efforts to elevate hospital performance in risk-adjusted 30-day mortality for patients with AMI. We will work on dissemination strategies with CMS, JCAHO, American College of Cardiology (ACC), American Health Association (AHA), the Veteran's Administration (VA), and the VHA.
Funding Period: 2007-09-30 - 2011-09-29
more information: NIH RePORT

Top Publications

  1. pmc Hospital collaboration with emergency medical services in the care of patients with acute myocardial infarction: perspectives from key hospital staff
    Adam B Landman
    Department of Emergency Medicine, Brigham and Women s Hospital, Boston, MA, USA
    Ann Emerg Med 61:185-95. 2013
  2. pmc Features of high quality discharge planning for patients following acute myocardial infarction
    Emily J Cherlin
    Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520 8034, USA
    J Gen Intern Med 28:436-43. 2013
  3. doi Variation in hospital mortality rates for patients with acute myocardial infarction
    Elizabeth H Bradley
    Section of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA
    Am J Cardiol 106:1108-12. 2010
  4. pmc Trends in comorbidity, disability, and polypharmacy in heart failure
    Catherine Y Wong
    Weill Cornell Medical College, New York, NY, USA
    Am J Med 124:136-43. 2011
  5. doi What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study
    Leslie A Curry
    Yale School of Public Health, Yale University School of Medicine, Yale New Haven Hospital, Connecticut, USA
    Ann Intern Med 154:384-90. 2011
  6. pmc An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction
    Harlan M Krumholz
    Section of Cardiovascular Medicine and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, and School of Public Health, Yale University School of Medicine, New Haven, CT 06510, USA
    Circ Cardiovasc Qual Outcomes 4:243-52. 2011
  7. pmc Quality of care in the US territories
    Marcella Nunez-Smith
    Department of Medicine, Yale UniversitySchool of Medicine, PO Box 208088, IE 61 SHM, New Haven, CT 06520, USA
    Arch Intern Med 171:1528-40. 2011
  8. pmc Survival after acute myocardial infarction (SAMI) study: the design and implementation of a positive deviance study
    Harlan M Krumholz
    Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
    Am Heart J 162:981-987.e9. 2011
  9. pmc Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction
    Elizabeth H Bradley
    Yale School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
    Ann Intern Med 156:618-26. 2012

Scientific Experts

Detail Information

Publications9

  1. pmc Hospital collaboration with emergency medical services in the care of patients with acute myocardial infarction: perspectives from key hospital staff
    Adam B Landman
    Department of Emergency Medicine, Brigham and Women s Hospital, Boston, MA, USA
    Ann Emerg Med 61:185-95. 2013
    ..We seek to characterize views of key hospital staff about collaboration with EMS in the care of patients hospitalized with acute myocardial infarction...
  2. pmc Features of high quality discharge planning for patients following acute myocardial infarction
    Emily J Cherlin
    Department of Health Policy and Management, Yale School of Public Health, New Haven, CT 06520 8034, USA
    J Gen Intern Med 28:436-43. 2013
    ....
  3. doi Variation in hospital mortality rates for patients with acute myocardial infarction
    Elizabeth H Bradley
    Section of Health Policy and Administration, Yale School of Public Health, New Haven, Connecticut, USA
    Am J Cardiol 106:1108-12. 2010
    ..05) associated with 30-day RSMRs. In conclusion, substantial variation in hospital outcomes for patients with AMI remains unexplained by measurements of hospital characteristics including SES patient profile...
  4. pmc Trends in comorbidity, disability, and polypharmacy in heart failure
    Catherine Y Wong
    Weill Cornell Medical College, New York, NY, USA
    Am J Med 124:136-43. 2011
    ..Our objective was to assess trends in demographics, comorbidity, physical function, and medication use in a nationally representative, community-based heart failure population...
  5. doi What distinguishes top-performing hospitals in acute myocardial infarction mortality rates? A qualitative study
    Leslie A Curry
    Yale School of Public Health, Yale University School of Medicine, Yale New Haven Hospital, Connecticut, USA
    Ann Intern Med 154:384-90. 2011
    ..Mortality rates for patients with acute myocardial infarction (AMI) vary substantially across hospitals, even when adjusted for patient severity; however, little is known about hospital factors that may influence this variation...
  6. pmc An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction
    Harlan M Krumholz
    Section of Cardiovascular Medicine and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, and School of Public Health, Yale University School of Medicine, New Haven, CT 06510, USA
    Circ Cardiovasc Qual Outcomes 4:243-52. 2011
    ....
  7. pmc Quality of care in the US territories
    Marcella Nunez-Smith
    Department of Medicine, Yale UniversitySchool of Medicine, PO Box 208088, IE 61 SHM, New Haven, CT 06520, USA
    Arch Intern Med 171:1528-40. 2011
    ..Health care quality in the US territories is poorly characterized. We used process measures to compare the performance of hospitals in the US territories and in the US states...
  8. pmc Survival after acute myocardial infarction (SAMI) study: the design and implementation of a positive deviance study
    Harlan M Krumholz
    Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
    Am Heart J 162:981-987.e9. 2011
    ..This type of study, using a positive deviance approach and mixed-methods design, can generate and test hypotheses about factors most strongly associated with exemplary performance based on practices currently in use...
  9. pmc Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction
    Elizabeth H Bradley
    Yale School of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
    Ann Intern Med 156:618-26. 2012
    ..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...