Survival after Acute Myocardial Infarction (SAMI) Study: The Design and Implementation of a Positive Deviance Study

• Published in: American Heart Journal
• Main Authors: Krumholz, Harlan M., Curry, Leslie A., Bradley, Elizabeth H.
• Format: Text
• Language: English
• Published: 2011
• Subjects: Article; sami
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688068; http://www.ncbi.nlm.nih.gov/pubmed/22137070; https://doi.org/10.1016/j.ahj.2011.09.004

Positive deviance studies combining qualitative and quantitative designs – a mixed methods approach – can discover strategies to produce exemplary performance. We present the Survival after Acute Myocardial Infarction (SAMI) study, a national positive deviance study to discover hospital strategies associated with lower 30-day hospital risk-standardized mortality rates (RSMRs). There is marked variation across hospitals in 30-day hospital RSMRs for patients with acute myocardial infarction (AMI) and little information about what accounts for differences in performance. We first conducted a qualitative study of hospitals in the U.S. (n=11; 158 key staff) that ranked in the top 5% of RSMRs for each of the 2 most recent years of data (2005–2006, 2006–2007) from the Centers for Medicare & Medicaid Services (CMS) at the time of sample selection and in the bottom 5% for contrast, with diversity among hospitals in key characteristics. Using hypotheses generated in this qualitative stage, we constructed a quantitative survey that was administered in a cross-sectional study of acute care hospitals in the U.S. operating from July 1, 2005 through June 30, 2008 that publicly reported CMS data for RSMRs during this time. We included hospitals with at least 75 AMI discharges during the 3-year period. Of the 600 hospitals we attempted to contact, 10 had closed, leaving a final sample of 590, of which 537 responded (91%). This type of study, using a positive deviance approach and mixed methods design, can generate and test hypotheses about factors most strongly associated with exemplary performance based on practices currently in use.