Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks
| Autor: | Lars S. Maier, Hans G Olbrich, Claus Fleischmann, Hiller Moehlis, Björn Lengenfelder, Sebastian Maier, Thomas Meyer, Kurt Bestehorn, Jens Jung, Tim Friede, Claudius Jacobshagen, Karl Heinrich Scholz |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Quality management business.industry medicine.medical_treatment Percutaneous coronary intervention General Medicine 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine medicine.disease 3. Good health Term (time) 03 medical and health sciences 0302 clinical medicine Reperfusion therapy medicine 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine Intensive care medicine business |
| Zdroj: | European heart journal. Acute cardiovascular care. |
| ISSN: | 2048-8734 |
| Popis: | Aims Current European Society of Cardiology guidelines state that repetitive monitoring and feedback should be implemented for ST-elevation myocardial infarction (STEMI) treatment, but no evidence is available supporting this recommendation. We aimed to analyze the long-term effects of a formalized data assessment and systematic feedback on performance and mortality within the prospective, multicenter Feedback Intervention and Treatment Times in STEMI (FITT-STEMI) study. Methods Regular interactive feedback sessions with local STEMI management teams were performed at six participating German percutaneous coronary intervention (PCI) centers over a 10-year period starting from October 2007. Results From the first to the 10th year of study participation, all predefined key-quality indicators for performance measurement used for feedback improved significantly in all 4926 consecutive PCI-treated patients – namely, the percentages of patients with pre-hospital electrocardiogram (ECG) recordings (83.3% vs 97.1%, p < 0.0001) and ECG recordings within 10 minutes after first medical contact (41.7% vs 63.8%, p < 0.0001), pre-announcement by telephone (77.0% vs 85.4%, p = 0.0007), direct transfer to the catheterization laboratory bypassing the emergency department (29.4% vs 64.2%, p < 0.0001), and contact-to-balloon times of less than 90 minutes (37.2% vs 53.7%, p < 0.0001). Moreover, this feedback-related continuous improvement of key-quality indicators was linked to a significant reduction in in-hospital mortality from 10.8% to 6.8% (p = 0.0244). Logistic regression models confirmed an independent beneficial effect of duration of study participation on hospital mortality (odds ratio = 0.986, 95% confidence interval = 0.976–0.996, p = 0.0087). In contrast, data from a nationwide PCI registry showed a continuous increase in in-hospital mortality in all PCI-treated STEMI patients in Germany from 2008 to 2015 (n = 398,027; 6.7% to 9.2%, p < 0.0001). Conclusions Our results indicate that systematic data assessment and regular feedback is a feasible long-term strategy and may be linked to improved performance and a reduction in mortality in STEMI management. |
| Databáze: | OpenAIRE |
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