Abstract

This proposal is a competitive renewal of """"""""Hospital Performance and Beta-Blocker Use After AMI"""""""" (R01 HS10407), a currently-funded study evaluating hospital strategies to increase beta-blocker prescription at discharge among patients hospitalized with an acute myocardial infarction. In this competitive renewal, we seek to examine variations in hospitals' improvements in time to acute reperfusion therapy (fibdnolytic therapy or percutaneous coronary intervention (PCI)) and to evaluate the effectiveness of different quality improvement strategies in reducing time to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). ? ? Although reducing time to reperfusion therapy is a national health care priority, there are no national data concerning hospitals' quality improvement strategies directed at improving this aspect of AMI care or information concerning their effectiveness. Accordingly, we seek to 1) determine the extent of hospital-level variation in changes in the time to reperfusion therapy for patients with STEMI, 2) catalogue and classify hospital quality improvement strategies directed at improving time to reperfusion therapy, and 3) identify hospital quality improvement strategies that are associated with improvements in time to reperfusion therapy. ? ? To accomplish our aims, we will combine medical record data from the National Registry of Myocardial Infarction (NRMI) database with originally collected survey data concerning the presence, type and duration of hospital-based quality improvement strategies directed at time to reperfusion therapy. Our approach will allow us to investigate variation in time to reperfusion therapy among hospitals, develop a taxonomy of efforts to reduce time to reperfusion therapy, and empirically identify successful strategies for improving hospital performance. Data generated from these studies will guide efforts by clinicians, administrators, researchers, and policy makers to decrease time to reperfusion therapy for patients with STEMI. ? ? ?

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
9R01HL072575-04
Application #
6578353
Study Section
Special Emphasis Panel (ZRG1-SNEM-4 (01))
Program Officer
Cooper, Lawton S
Project Start
1999-09-30
Project End
2006-01-31
Budget Start
2003-03-11
Budget End
2004-01-31
Support Year
4
Fiscal Year
2003
Total Cost
$783,362
Indirect Cost

  Institution

Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520

  Publications

Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H (2015) Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning. Med Care Res Rev 72:707-35
Nembhard, Ingrid M; Cherian, Praseetha; Bradley, Elizabeth H (2014) Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement. Med Care Res Rev 71:450-71
Nallamothu, Brahmajee K; Spertus, John A; Lansky, Alexandra J et al. (2013) Comparison of clinical interpretation with visual assessment and quantitative coronary angiography in patients undergoing percutaneous coronary intervention in contemporary practice: the Assessing Angiography (A2) project. Circulation 127:1793-800
Santana, Calie; Curry, Leslie A; Nembhard, Ingrid M et al. (2011) Behaviors of successful interdisciplinary hospital quality improvement teams. J Hosp Med 6:501-6
Bradley, Elizabeth H; Nallamothu, Brahmajee K; Stern, Amy F et al. (2009) The door-to-balloon alliance for quality: who joins national collaborative efforts and why? Jt Comm J Qual Patient Saf 35:93-9
Rathore, Saif S; Curtis, Jeptha P; Nallamothu, Brahmajee K et al. (2009) Association of door-to-balloon time and mortality in patients > or =65 years with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 104:1198-203
Ting, Henry H; Bradley, Elizabeth H; Wang, Yongfei et al. (2008) Delay in presentation and reperfusion therapy in ST-elevation myocardial infarction. Am J Med 121:316-23
Webster, Tashonna R; Curry, Leslie; Berg, David et al. (2008) Organizational resiliency: how top-performing hospitals respond to setbacks in improving quality of cardiac care. J Healthc Manag 53:169-81;discussion 181-2
Chakrabarti, Anjan; Krumholz, Harlan M; Wang, Yongfei et al. (2008) Time-to-reperfusion in patients undergoing interhospital transfer for primary percutaneous coronary intervention in the U.S: an analysis of 2005 and 2006 data from the National Cardiovascular Data Registry. J Am Coll Cardiol 51:2442-3
Ting, Henry H; Bradley, Elizabeth H; Wang, Yongfei et al. (2008) Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. Arch Intern Med 168:959-68

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