Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Mixed Methods Program and Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Acute Care Research Unit, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Qualitative and Mixed Methods Core, Center for Clinical Management Research, U.S. Department of Veterans Affairs, Ann Arbor, MI.
Am Heart J. 2023 Dec;266:106-119. doi: 10.1016/j.ahj.2023.09.004. Epub 2023 Sep 12.
Out-of-hospital cardiac arrest (OHCA) affects over 300,000 individuals per year in the United States with poor survival rates overall. A remarkable 5-fold difference in survival-to-hospital discharge rates exist across United States communities.
We conducted a study using qualitative research methods comparing the system of care across sites in Michigan communities with varying OHCA survival outcomes, as measured by return to spontaneous circulation with pulse upon emergency department arrival.
Major themes distinguishing higher performing sites were (1) working as a team, (2) devoting resources to coordination across agencies, and (3) developing a continuous quality improvement culture. These themes spanned the chain of survival framework for OHCA. By examining the unique processes, procedures, and characteristics of higher- relative to lower-performing sites, we gleaned lessons learned that appear to distinguish higher performers. The higher performing sites reported being the most collaborative, due in part to facilitation of system integration by progressive leadership that is willing to build bridges among stakeholders.
Based on the distinguishing features of higher performing sites, we provide recommendations for toolkit development to improve survival in prehospital systems of care for OHCA.
美国每年有超过 30 万人发生院外心脏骤停 (OHCA)，总体存活率较低。美国各社区的存活率到出院率差异显著，高达 5 倍。
我们使用定性研究方法进行了一项研究，比较了密歇根州不同 OHCA 存活率社区之间的护理系统，存活率通过急诊室到达时恢复自主循环和脉搏来衡量。
表现较好的站点的主要特点是：(1) 团队合作，(2) 致力于协调各机构之间的资源，(3) 培养持续质量改进文化。这些主题跨越了 OHCA 的生存链框架。通过检查表现较好和较差站点的独特流程、程序和特点，我们汲取了一些经验教训，这些经验教训似乎可以区分表现较好的站点。表现较好的站点报告说他们的协作性最强，部分原因是渐进式领导促进了系统整合，愿意在利益相关者之间架起桥梁。
根据表现较好站点的区别特征，我们提供了工具包开发建议，以改善 OHCA 院前护理系统的生存。
