RESUMEN
Aims: To determine whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol is associated with reduced sex disparities over 5 years. Methods and results: This was an observational cohort study of 1833 consecutive STEMI patients treated with percutaneous coronary intervention (PCI) before (1 January 2011-14 July 2014, control group) and after (15 July 2014-15 July 2019, protocol group) implementation of a protocol for early guideline-directed medical therapy (GDMT), rapid door to balloon time (D2BT), and use of trans-radial PCI. In the control group, females had less GDMT (77.1% vs. 68.1%, P = 0.03), similarly low trans-radial PCI (19.0% vs. 17.6%, P = 0.73), and longer D2BT [104 min (79, 133) vs. 112 min (85, 147), P = 0.02] corresponding to higher in-hospital mortality [4.5% vs. 10.3%, odds ratio (OR) 2.44 (1.34-4.46), P = 0.004], major adverse cardiac and cerebrovascular events [MACCE, 9.8% vs. 16.3%, OR 1.79 (1.14-2.84), P = 0.01], and net adverse clinical events [NACE, 16.1% vs. 28.3%, OR 2.06 (1.42-2.99), P < 0.001]. In the protocol group, no significant sex differences were observed in GDMT (87.2% vs. 86.4%, P = 0.81) or D2BT [85 min (64-106) vs. 89 min (65-111), P = 0.06], but trans-radial PCI was used less in females (77.6% vs. 71.2%, P = 0.03). In-hospital mortality [2.5% vs. 4.4%, OR 1.78 (0.91-3.51), P = 0.09] and MACCE [9.0% vs. 11.1%, OR 1.27 (0.83-1.92), P = 0.26] were similar between sexes, but higher NACE in females approached significance [14.8% vs. 19.4%, OR 1.38 (0.99-1.92), P = 0.05] due to higher bleeding risk [7.2% vs. 11.1%, OR 1.60 (1.04-2.46), P = 0.03]. Conclusions: A comprehensive STEMI protocol was associated with sustained reductions for in-hospital ischaemic outcomes over 5 years, but higher bleeding rates in females persisted.
RESUMEN
OBJECTIVE: Ongoing professional practice evaluation (OPPE) is designed to identify professional practice trends that affect quality and safety of practicing physicians. Focused professional practice evaluation (FPPE) is employed when physician nonconformance is identified. The goal of this novel OPPE initiative was threefold: (1) meet The Joint Commission's accreditation standards, (2) assess documentation for compliance and risk, and (3) maintain procedural competency to provide optimal patient care. METHODS: A quality assurance project with OPPE program development was initiated in 18 emergency departments across a large health care system. First, a monthly comprehensive peer review meeting assessed cases across the system for medicolegal risk. Physicians with reasonable practice concerns were identified and referred to FPPE. Second, a standardized OPPE chart review was performed biannually by a quality assurance committee assessing all physician charts for clinical care, medicolegal risk, and quality. Last, completion of a procedure lab every three years was required to maintain competency. OUTCOMES: For systemwide peer review in 2019, 47 cases were referred and 12.8% had quality concerns. For standardized OPPE chart review, 221 physicians were reviewed on 1,219 charts on the following metrics: insufficient medical decision making, diagnoses not medical/legally supported, and charts with red flags. Nine physicians (4.1%) and 17 charts (1.4%) were deficient in all three measures, and 8 physicians (3.6%) had deficiencies in ≥ 50% of their charts. For procedure lab competency, 19.0% of physicians completed the lab in 2019 with no quality concerns. CONCLUSION: A structured OPPE algorithm can aid large health care systems in identifying deviations from practice standards for which additional FPPE can be beneficial.
