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Title
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Care pathway effect on n-hospital care for ST-elevation myocardial infarction
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Author
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Abstract
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| Objectives: To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction (STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. Methods: A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. Results: Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. Conclusions: After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement. (C) 2018 S. Karger AG, Basel |
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Language
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English
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Source (journal)
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Cardiology. - Basel
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Publication
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Basel
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2018
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ISSN
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0008-6312
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DOI
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10.1159/000488932
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Volume/pages
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140
:3
(2018)
, p. 163-174
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ISI
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000448323400007
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Pubmed ID
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30099470
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Full text (Publisher's DOI)
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Full text (publisher's version - intranet only)
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