Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis

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...

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Main Authors: Junxiong Ma, Xuejie Dong, Yinzi Jin, Zhi-Jie Zheng
Format: Article
Language:English
Published: MDPI AG 2021-06-01
Series:International Journal of Environmental Research and Public Health
Subjects:
Online Access:https://www.mdpi.com/1660-4601/18/11/6045
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spelling doaj-8239df9c56d54c0d8a8cfa4a1ce23c672021-06-30T23:17:56ZengMDPI AGInternational Journal of Environmental Research and Public Health1661-78271660-46012021-06-01186045604510.3390/ijerph18116045Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching AnalysisJunxiong Ma0Xuejie Dong1Yinzi Jin2Zhi-Jie Zheng3Department of Global Health, School of Public Health, Peking University, Beijing 100191, ChinaDepartment of Global Health, School of Public Health, Peking University, Beijing 100191, ChinaDepartment of Global Health, School of Public Health, Peking University, Beijing 100191, ChinaDepartment of Global Health, School of Public Health, Peking University, Beijing 100191, ChinaReducing 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 (<i>p</i> < 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.https://www.mdpi.com/1660-4601/18/11/6045chest pain centerquality improvementSTEMI
collection DOAJ
language English
format Article
sources DOAJ
author Junxiong Ma
Xuejie Dong
Yinzi Jin
Zhi-Jie Zheng
spellingShingle Junxiong Ma
Xuejie Dong
Yinzi Jin
Zhi-Jie Zheng
Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
International Journal of Environmental Research and Public Health
chest pain center
quality improvement
STEMI
author_facet Junxiong Ma
Xuejie Dong
Yinzi Jin
Zhi-Jie Zheng
author_sort Junxiong Ma
title Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
title_short Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
title_full Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
title_fullStr Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
title_full_unstemmed Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis
title_sort health care quality improvement for st-segment elevation myocardial infarction: a retrospective study based on propensity-score matching analysis
publisher MDPI AG
series International Journal of Environmental Research and Public Health
issn 1661-7827
1660-4601
publishDate 2021-06-01
description 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 (<i>p</i> < 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.
topic chest pain center
quality improvement
STEMI
url https://www.mdpi.com/1660-4601/18/11/6045
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