Key result
Quality improvement implementation for STEMI care significantly reduced door-to-balloon time (85.0 to 78 min) and FMC-to-device time (98.0 to 88 min) (p<0.001), but did not decrease mortality.
Why the study?
Reducing treatment delay by organizing regional care is a priority in STEMI, motivating this evaluation of combined quality measures on healthcare delivery metrics in Suzhou.
Does regional quality improvement implementation improve process metrics and clinical outcomes in patients with STEMI?
Observational (n=4,775)
Yes
Does regional quality improvement implementation improve process metrics and clinical outcomes in patients with STEMI?
Absolute Event Rate: 78% vs 85%
p-value: p=<0.001
Regional quality improvement initiatives for STEMI care significantly improve process metrics like door-to-balloon time but may not immediately translate to reduced in-hospital mortality, highlighting the need to address prehospital delays.
STEMI quality improvement shortened times without mortality benefit; leaves open whether sustained or prehospital efforts are needed.
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.
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Ma et al. (2021) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=4,775). Quality improvement implementation vs. Pre-implementation was evaluated on Door-to-balloon time (minutes) (p=<0.001). Quality improvement implementation for STEMI care significantly reduced door-to-balloon time (85.0 to 78 min) and FMC-to-device time (98.0 to 88 min) (p<0.001), but did not decrease mortality.
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