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See Latest ArticlesReduction in acute myocardial infarction mortality in the United States: Risk-standardized mortality rates from 1995-2006
JAMA, 08/21/09
Krumholz HM et al. – Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare pts discharged with acute myocardial infarction (AMI) showed a significant decrease, as did between-hospital variation.
Methods- Study to estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for pts discharged with AMI
- Observational study using administrative data and a validated risk model
- Evaluation of 3,195,672 discharges in 2,755,370 pts discharged from US nonfederal acute care hospitals January 1, 1995-December 31, 2006
- Pts age ≥65 yrs (mean, 78 yrs) with ≥12-mo history of fee-for-service enrollment prior to index hospitalization
- Exclusion of pts discharged alive within 1 day of admission not against medical advice (due to unlikely AMI)
- Main outcome measure: hospital-specific 30-day all-cause RSMR
- At pt level, odds of dying within 30 days of admission if treated at a hospital 1 SD above national average vs 1 SD below national average: 1.63 in 1995 and 1.56 in 2006
- Hospital-specific RSMRs: decrease from 18.8% in 1995 to 15.8% in 2006
- Reduction in between-hospital heterogeneity in RSMRs: coefficient of variation decreased from 11.2% in 1995 to 10.8%, interquartile range from 2.8% to 2.1%, and between-hospital variance from 4.4% to 2.9%
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