Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis

Abstract

Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.

Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies

“…Variables included in the models were selected based on their physiological relevance and potential to be associated with outcomes. We initiated the model development with a crude model (no adjustment) and then added a range of covariates into the regression models based on previous studies in the literature [14,[17][18][19]. All the models were adjusted for sex, age, signs and symptoms at presentation, heart rate, blood pressure and Killip class, arrival mode, time of day of arrival, day of arrival, class of hospital, region of hospital, and accreditation status.…”

Impact of a New Referral System on Time to Treatment in Referred STEMI Patients Compared With Traditional Referral System at Maharat Nakhon Ratchasima Hospital

“…The system of care for STEMI patients in community hospitals, including emergency and network referral systems, plays an important role in providing appropriate and timely treatment. 8 However, despite these systems, the mortality rate remains high, and most patients still experience delayed access to treatment. Delayed transfer of STEMI patients to the catheterization room is associated with poor outcomes and high mortality.…”

Factors Associated With Medical Staff’s Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed‐Methods Study in China

“… 2 , 3 , 4 , 5 However, previous research has found that quality of health care services frequently falls short of basic clinical standards or QI program performance targets, with most interventions improving process quality indicators, such as drug use, but not outcome quality, especially in‐hospital mortality and major adverse cardiovascular events. 6 , 7 , 8 , 9 Broad consultation with stakeholders, particularly frontline medical staff, is crucial to understanding the gaps between “what we know” and “what we do,” especially in a complex QI program. 10 , 11 The engagement and perception of frontline medical professionals with respect to QI programs are prerequisites for successful implementation of QI interventions.…”