Strategies to reduce time to reperfusion therapy for MI

描述(由申请人提供)：这项提案是“急性心肌梗死后的医院表现和β-受体阻滞剂使用”(R01 HS10407)的竞争性更新，这是一项目前由医院资助的研究，旨在评估医院在急性心肌梗死住院患者出院时增加β-受体阻滞剂处方的策略。在这一竞争更新中，我们试图检查医院在急性再灌注治疗(纤溶治疗或经皮冠状动脉介入治疗(PCI))的时间改善方面的差异，并评估不同质量改进策略在缩短ST段抬高型心肌梗死(STEMI)患者再灌注治疗时间方面的有效性。 虽然缩短再灌注治疗的时间是国家医疗保健的优先事项，但没有关于医院旨在改善这方面的急性心肌梗死护理的质量改进战略的国家数据，也没有关于其有效性的信息。因此，我们试图1)确定STEMI患者再通治疗时间变化的医院水平差异程度，2)针对改善再灌注治疗时间的医院质量改进策略进行目录和分类，以及3)确定与改善再灌注治疗时间相关的医院质量改进策略。 为了实现我们的目标，我们将把国家心肌梗死登记处(NRMI)数据库的病历数据与最初收集的调查数据结合起来，这些调查数据涉及针对再灌注治疗时间的基于医院的质量改进策略的存在、类型和持续时间。我们的方法将使我们能够调查不同医院之间再灌注治疗时间的差异，制定努力减少再灌注治疗时间的分类，并经验地确定改善医院绩效的成功策略。这些研究产生的数据将指导临床医生、管理者、研究人员和政策制定者努力减少STEMI患者的再灌注治疗时间。

DESCRIPTION (provided by applicant): This proposal is a competitive renewal of "Hospital Performance and Beta-Blocker Use After AMI" (R01 HS10407), a currently-funded study evaluating hospital strategies to increase beta-blocker prescription at discharge among patients hospitalized with an acute myocardial infarction. In this competitive renewal, we seek to examine variations in hospitals' improvements in time to acute reperfusion therapy (fibdnolytic therapy or percutaneous coronary intervention (PCI)) and to evaluate the effectiveness of different quality improvement strategies in reducing time to reperfusion therapy for patients with ST-segment elevation myocardial infarction (STEMI). Although reducing time to reperfusion therapy is a national health care priority, there are no national data concerning hospitals' quality improvement strategies directed at improving this aspect of AMI care or information concerning their effectiveness. Accordingly, we seek to 1) determine the extent of hospital-level variation in changes in the time to reperfusion therapy for patients with STEMI, 2) catalogue and classify hospital quality improvement strategies directed at improving time to reperfusion therapy, and 3) identify hospital quality improvement strategies that are associated with improvements in time to reperfusion therapy. To accomplish our aims, we will combine medical record data from the National Registry of Myocardial Infarction (NRMI) database with originally collected survey data concerning the presence, type and duration of hospital-based quality improvement strategies directed at time to reperfusion therapy. Our approach will allow us to investigate variation in time to reperfusion therapy among hospitals, develop a taxonomy of efforts to reduce time to reperfusion therapy, and empirically identify successful strategies for improving hospital performance. Data generated from these studies will guide efforts by clinicians, administrators, researchers, and policy makers to decrease time to reperfusion therapy for patients with STEMI.