Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction.
Cardiology
; 140(3): 163-174, 2018.
Article
in En
| MEDLINE
| ID: mdl-30099470
ABSTRACT
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Critical Pathways
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
/
Hospitalization
Type of study:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Cardiology
Year:
2018
Document type:
Article
Affiliation country: