Impact of Regionalization of ST-Segment–Elevation Myocardial Infarction Care on Treatment Times and Outcomes for Emergency Medical Services–Transported Patients Presenting to Hospitals With Percutaneous Coronary Intervention
| Autor: | Christopher B. Fordyce, Hussein R. Al-Khalidi, Jacqueline E. Tamis-Holland, Peter B. Berger, Mayme L. Roettig, Shannon M. Doerfler, Thomas D. Rea, Khaled M. Ziada, James J. McCarthy, Lori Hollowell, Claire C. Corbett, Jay Shavadia, James G. Jollis, Zainab Magdon-Ismail, Peter K. O’Brien, Lisa Monk, B. Hadley Wilson, Ajar Kochar, Timothy D. Henry, Christopher B. Granger |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology Regional Health Planning Time-to-Treatment 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Risk Factors Physiology (medical) Outcome Assessment Health Care Emergency medical services Humans Medicine ST segment In patient Registries 030212 general & internal medicine Myocardial infarction Healthcare Disparities Health policy Aged Delivery of Health Care Integrated business.industry Percutaneous coronary intervention Middle Aged medicine.disease United States Hospitalization Elevation (emotion) Transportation of Patients Treatment Outcome Emergency medicine ST Elevation Myocardial Infarction Female Cardiology Service Hospital Emergency Service Hospital Cardiology and Cardiovascular Medicine business Program Evaluation |
| Zdroj: | Circulation. 137:376-387 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circulationaha.117.032446 |
| Popis: | Background: Regional variations in reperfusion times and mortality in patients with ST-segment–elevation myocardial infarction are influenced by differences in coordinating care between emergency medical services (EMS) and hospitals. Building on the Accelerator-1 Project, we hypothesized that time to reperfusion could be further reduced with enhanced regional efforts. Methods: Between April 2015 and March 2017, we worked with 12 metropolitan regions across the United States with 132 percutaneous coronary intervention–capable hospitals and 946 EMS agencies. Data were collected in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network)-Get With The Guidelines Registry for quarterly Mission: Lifeline reports. The primary end point was the change in the proportion of EMS-transported patients with first medical contact to device time ≤90 minutes from baseline to final quarter. We also compared treatment times and mortality with patients treated in hospitals not participating in the project during the corresponding time period. Results: During the study period, 10 730 patients were transported to percutaneous coronary intervention–capable hospitals, including 974 in the baseline quarter and 972 in the final quarter who met inclusion criteria. Median age was 61 years; 27% were women, 6% had cardiac arrest, and 6% had shock on admission; 10% were black, 12% were Latino, and 10% were uninsured. By the end of the intervention, all process measures reflecting coordination between EMS and hospitals had improved, including the proportion of patients with a first medical contact to device time of ≤90 minutes (67%–74%; P P P P =0.001) that was not apparent in hospitals not participating in the project during the same time period. Conclusions: Organization of care among EMS and hospitals in 12 regions was associated with significant reductions in time to reperfusion in patients with ST-segment–elevation myocardial infarction as well as in in-hospital mortality. These findings support a more intensive regional approach to emergency care for patients with ST-segment–elevation myocardial infarction. |
| Databáze: | OpenAIRE |
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