Department of Global Health, School of Public Health, Peking University, Beijing 100191, China.
Institute for Global Health, Peking University, Beijing 100191, China.
Int J Environ Res Public Health. 2021 Jun 4;18(11):6045. doi: 10.3390/ijerph18116045.
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 ( < 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.
在区域基础上组织医疗服务以减少治疗延误是提高 ST 段抬高型心肌梗死（STEMI）护理质量的重点。本研究旨在评估联合措施对苏州医疗保健提供质量指标的影响。数据来自国家胸痛中心（CPC）数据报告数据库。共招募了 4775 名患者，经过倾向评分匹配后，最终纳入 1078 对进行分析。我们检查了护理质量指标的变化，包括院前和院内流程以及临床结果。质量改进（QI）实施改善了大多数流程指标。然而，这些改进并没有降低院内死亡率。门球时间和 FMC 至器械时间分别从 85.0 和 98.0 分钟减少到 78 和 88 分钟（<0.001）。直接通过 EMS 转院的患者在大多数流程指标上的改善更大。直接通过 EMS 转院的患者比例为 10.3%，远低于自行转院患者的 58.3%。三级医院在流程指标方面的表现改善大于二级医院。郊区使用 EMS 的比例仍然较低。协调 STEMI 护理的建立需要伴随着解决院前和院内护理碎片化的问题，并且应该解决患者的延误问题，特别是在郊区和转院的住院患者中。
