Hospital strategies to improve outcome performance

医院改善治疗效果的策略

• 批准号: 7941856
• 负责人: Elizabeth Howe Bradley
• 金额: $ 22.24万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-30 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7941856
• 关键词: Hospital; strategies; improve; outcome; performance

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.

描述（由申请人提供）：尽管十年来努力改善急性心肌梗死 (AMI) 患者的护理，但不同医院的 AMI 后患者死亡率仍然存在很大差异。 2003年医院经风险调整后的30天死亡率在11%到23%之间，相差两倍多。 尽管患者生存是住院治疗的一个基本目标，但我们对风险调整短期死亡率较低的医院有何独特之处知之甚少。 大量医疗保健组织理论认为，医院结构、流程和内部环境可能会影响医院的运营和财务结果；然而，关于它们对临床结果的影响，我们的经验证据较少；例如风险调整死亡率，尤其是 AMI 患者。 我们将使用混合方法来：1) 生成有关医院特定工作的假设（以支持结构、护理流程和医院内部环境为特征），这些假设可能与 AMI 患者的医院风险调整后 30 天死亡率相关； 2) 确定与 AMI 患者医院风险调整后 30 天死亡率统计相关的医院工作量。 该方法以互补的方式采用定性和定量研究来生成并检验假设。 我们采用经过验证的风险调整死亡率模型和分层广义线性模型来检查医院层面风险调整死亡率的变化。 该风险调整模型已得到国家质量论坛的认可，并计划于 2007 年被医疗保险和医疗补助服务中心 (CMS) 作为公开报告的质量指标。缺乏证据说明医院层面风险调整死亡率差异的原因是我们目前关于如何改善结果的知识中的一个关键差距。 拟议的研究将为基于证据的努力提供基础，以提高医院在 AMI 患者风险调整后 30 天死亡率方面的表现。 我们将与 CMS、JCAHO、美国心脏病学会 (ACC)、美国健康协会 (AHA)、退伍军人管理局 (VA) 和 VHA 合作制定传播策略。

项目成果

Trends in comorbidity, disability, and polypharmacy in heart failure.

• DOI: 10.1016/j.amjmed.2010.08.017
• 发表时间: 2011-02
• 期刊: AMERICAN JOURNAL OF MEDICINE
• 影响因子: 5.9
• 作者: Wong, Catherine Y.;Chaudhry, Sarwat I.;Desai, Mayur M.;Krumholz, Harlan M.
• 通讯作者: Krumholz, Harlan M.

An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction.

• DOI: 10.1161/circoutcomes.110.957498
• 发表时间: 2011-03
• 期刊: Circulation. Cardiovascular quality and outcomes
• 作者: Krumholz HM;Lin Z;Drye EE;Desai MM;Han LF;Rapp MT;Mattera JA;Normand SL
• 通讯作者: Normand SL

An administrative claims measure of payments made for Medicare patients for a 30-day episode of care for acute myocardial infarction.

一项行政索赔措施，用于衡量 Medicare 患者因急性心肌梗塞而接受 30 天的护理所支付的费用。

• DOI: 10.1097/mlr.0000000000000361
• 发表时间: 2015
• 期刊: Medical care
• 影响因子: 3
• 作者: Kim,Nancy;Bernheim,SusannahM;Ott,LesliS;Han,Lein;Spivack,StevenB;Xu,Xiao;Volpe,Mark;Liu,Alex;Krumholz,HarlanM
• 通讯作者: Krumholz,HarlanM

Hospital collaboration with emergency medical services in the care of patients with acute myocardial infarction: perspectives from key hospital staff.

• DOI: 10.1016/j.annemergmed.2012.10.009
• 发表时间: 2013-02
• 期刊: ANNALS OF EMERGENCY MEDICINE
• 影响因子: 6.2
• 作者: Landman, Adam B.;Spatz, Erica S.;Cherlin, Emily J.;Krumholz, Harlan M.;Bradley, Elizabeth H.;Curry, Leslie A.
• 通讯作者: Curry, Leslie A.