Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies

(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity t...

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Autores principales:	Na Li, Junxiong Ma, Shuduo Zhou, Xuejie Dong, Mailikezhati Maimaitiming, Yinzi Jin, Zhijie Zheng
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	chest pain center accreditation healthcare quality improvement door-to-balloon time arrival mode ST-segment elevation myocardial infarction Medicine R
Acceso en línea:	https://doaj.org/article/876b9045fb734dd7a3a44e29501853df
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spelling	oai:doaj.org-article:876b9045fb734dd7a3a44e29501853df2021-11-25T17:44:15ZCan a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies10.3390/healthcare91114622227-9032https://doaj.org/article/876b9045fb734dd7a3a44e29501853df2021-10-01T00:00:00Zhttps://www.mdpi.com/2227-9032/9/11/1462https://doaj.org/toc/2227-9032(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes.Na LiJunxiong MaShuduo ZhouXuejie DongMailikezhati MaimaitimingYinzi JinZhijie ZhengMDPI AGarticlechest pain center accreditationhealthcare quality improvementdoor-to-balloon timearrival modeST-segment elevation myocardial infarctionMedicineRENHealthcare, Vol 9, Iss 1462, p 1462 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chest pain center accreditation healthcare quality improvement door-to-balloon time arrival mode ST-segment elevation myocardial infarction Medicine R
spellingShingle	chest pain center accreditation healthcare quality improvement door-to-balloon time arrival mode ST-segment elevation myocardial infarction Medicine R Na Li Junxiong Ma Shuduo Zhou Xuejie Dong Mailikezhati Maimaitiming Yinzi Jin Zhijie Zheng Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
description	(1) Background: Chest pain center accreditation has been associated with improved timelines of primary percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI). However, evidence from low- and middle-income regions was insufficient, and whether the sensitivity to improvements differs between walk-in and emergency medical service (EMS)-transported patients remained unclear. In this study, we aimed to examine the association of chest pain center accreditation status with door-to-balloon (D2B) time and the potential modification effect of arrival mode. (2) Methods: The associations were examined using generalized linear mixed models, and the effect modification of arrival mode was examined by incorporating an interaction term in the models. (3) Results: In 4186 STEMI patients, during and after accreditation were respectively associated with 65% (95% CI: 54%, 73%) and 71% (95% CI: 61%, 79%) reduced risk of D2B time being more than 90 min (using before accreditation as the reference). Decreases of 27.88 (95% CI: 19.57, 36.22) minutes and 26.55 (95% CI: 17.45, 35.70) minutes in D2B were also observed for the during and after accreditation groups, respectively. The impact of accreditation on timeline improvement was greater for EMS-transported patients than for walk-in patients. (4) Conclusions: EMS-transported patients were more sensitive to the shortened in-hospital delay associated with the initiative, which could exacerbate the existing disparity among patients with different arrival modes.
format	article
author	Na Li Junxiong Ma Shuduo Zhou Xuejie Dong Mailikezhati Maimaitiming Yinzi Jin Zhijie Zheng
author_facet	Na Li Junxiong Ma Shuduo Zhou Xuejie Dong Mailikezhati Maimaitiming Yinzi Jin Zhijie Zheng
author_sort	Na Li
title	Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
title_short	Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
title_full	Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
title_fullStr	Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
title_full_unstemmed	Can a Healthcare Quality Improvement Initiative Reduce Disparity in the Treatment Delay among ST-Segment Elevation Myocardial Infarction Patients with Different Arrival Modes? Evidence from 33 General Hospitals and Their Anticipated Impact on Healthcare during Disasters and Public Health Emergencies
title_sort	can a healthcare quality improvement initiative reduce disparity in the treatment delay among st-segment elevation myocardial infarction patients with different arrival modes? evidence from 33 general hospitals and their anticipated impact on healthcare during disasters and public health emergencies
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/876b9045fb734dd7a3a44e29501853df
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