Bradley Elizabeth H, Sipsma Heather, Brewster Amanda L, Krumholz Harlan M, Curry Leslie
Department of Health Policy and Management, Yale School of Public Health, 60 College Street, PO Box 208034, New Haven, CT 06520-8034, USA.
BMC Cardiovasc Disord. 2014 Sep 24;14:126. doi: 10.1186/1471-2261-14-126.
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.
美国各医院急性心肌梗死（AMI）后的生存率差异显著。尽管已付出巨大努力来改善医院绩效，但我们缺乏关于可能有助于降低医院AMI死亡率的医院策略变化及组织文化特征的当代证据。我们试图描述全国医院样本中与AMI死亡率相关的几种策略和组织文化特征的当前使用情况，并研究2010年至2013年间使用情况的变化。
2013年我们对543家医院进行了横断面调查（回复率70%），并对2010年回复过调查的107家医院的子样本进行了纵向分析（回复率67%）。
2010年至2013年间，许多策略的使用有所增加，但只有两种策略的使用显著增加：为紧急医疗服务（EMS）提供者提供关于AMI护理定期培训的医院百分比从36%增至71%（P值<0.001），使用计算机辅助医生医嘱录入的医院百分比增加了一倍多（P值<0.001）。大多数但并非所有医院报告称拥有有利于沟通、协调和解决问题的环境。
我们发现2010年至2013年间，与较低AMI死亡率相关的医院策略或组织文化关键特征几乎没有显著变化。研究结果突出了帮助缩小医院间AMI死亡率剩余绩效差距的几个机会。
