Patients hospitalized with a heart attack are at high risk for dying within the next 30 days. Publicly reported data from the Center for Medicare and Medicaid Services demonstrate that 30-day mortality rates averages 15.9% for hospitals in the United States. However, even after adjusting for patient severity, 30-day mortality rates for heart attack patients vary 2.5-fold across hospitals in the U.S., with top performing hospitals with a 30 day mortality rate at 10.9% and lowest performing hospitals at 24.9%. Recently published mixed methods research has identified key hospital strategies associated with top performing hospitals with the lowest RSMR for patients with AMI;however, fewer than 10% of hospitals are consistently and routinely utilizing these strategies. The qualitative findings indicated top performing hospitals were distinguished by organizational approaches in five domains: organizational values and goals, senior management involvement, staff expertise;communication and coordination among staff, and problem solving and learning. The quantitative findings statistically link these aspects of organizational environment with RSMR;5 specific strategies are associated with better performance: holding monthly meetings between hospital clinicians and emergency medical services to review AMI cases, having cardiologists always on site, an organizational environment in which clinicians are encouraged to solve problems creatively, not cross-training nurses from intensive care units for the cardiac catheterization laboratory, and having physician and nurse champions rather than nurse champions alone. The current proposal from the American College of Cardiology, Survival after Acute Myocardial Infarction (SAMI) Alliance, seeks to develop a learning network of hospitals in order to disseminate and implement evidence-based hospital strategies to reduce 30-day mortality for patients with heart attack. SAMI Alliance will be a 3-year initiative led by the ACC and strategic partners to develop a learning network of hospitals to participate in a national quality initiative for patients hospitalized with AMI (Aim 1) and to disseminate and implement key hospital strategies to reduce RSMR using innovative educational methods (Aim 2). ACC will leverage the ARG of 725 participating hospitals for patients with AMI, existing infrastructure for collecting and reporting outcomes measures, and experience and expertise with innovative educational methods for dissemination and implementation. Key activities will include multiple diverse formats and approaches, including a kick-off event, workshops at professional society meetings, toolkits, change packages, webinars, online learning communities, and nodal hospital and peer-to-peer organizational learning. Comprehensive evaluation to assess adoption of recommended hospital strategies and changes in hospital RSMR and to determine hospital features that are associated with adoption of recommended strategies has already received funding from Commonwealth Fund and Donaghue Foundation (Aim 3). The ARG registry will be used as the data collection tool to identify areas for improvement pre-intervention and to define the impact post-intervention.
Patients hospitalized with a heart attack are at high risk for dying within the next 30 days. Publicly reported data from the Center for Medicare and Medicaid Services demonstrate that 30-day mortality rates averages 15.9% for hospitals in the United States. However, even after adjusting for patient severity, 30-day mortality rates for heart attack patients vary 2.5-fold across hospitals in the U.S., with top performing hospitals with a 30-day mortality rate at 10.9% and lowest performing hospitals at 24.9%. Recently published mixed methods research has identified key hospital strategies associated with top performing hospitals with the lowest RSMR for patients with AMI;however, fewer than 10% of hospitals are consistently and routinely utilizing these strategies. The qualitative findings indicated top performing hospitals were distinguished by organizational approaches in five domains: organizational values and goals, senior management involvement, staff expertise;communication and coordination among staff, and problem solving and learning. The quantitative findings statistically link these aspects of organizational environment with RSMR;5 specific strategies are associated with better performance: holding monthly meetings between hospital clinicians and emergency medical services to review AMI cases, having cardiologists always on site, an organizational environment in which clinicians are encouraged to solve problems creatively, not cross-training nurses from intensive care units for the cardiac catheterization laboratory, and having physician and nurse champions rather than nurse champions alone. The current proposal from the American College of Cardiology, Survival after Acute Myocardial Infarction (SAMI) Alliance, seeks to develop a learning network of hospitals in order to disseminate and implement evidence-based hospital strategies to reduce 30-day mortality for patients with heart attack.
