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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Cardiovascular Disorders 1/2014

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 > Ausgabe 1/2014
Elizabeth H Bradley, Heather Sipsma, Amanda L Brewster, Harlan M Krumholz, Leslie Curry
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2261-14-126) contains supplementary material, which is available to authorized users.

Competing interests

Dr. Bradley and Dr. Curry report that they are the recipients of a research grant from The Medicines Company. Dr. Krumholz reports that he is the recipient of a research grant from Medtronic through Yale University and chairs a cardiac scientific advisory board for United Health.

Authors’ contributions

EHB, LC, and HK conceptualized and designed the study. EHB and HK acquired the data. EHB, HS, ALB, HK and LC analyzed and interpreted the data. EHB, HS and AB drafted the manuscript. LC and HK critically revised the manuscript for important intellectual content. HS conducted the statistical analysis. EHB, HK and LC obtained funding for the study and EHB supervised the study. All authors read and approved the final manuscript.



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.


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).


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.


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.
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