Digital EMS Point of Care Innovation to Improve Rural STEMI Outcomes
Digital EMS Point of Care Innovation to Improve Rural STEMI Outcomes
批准号:
10811453
负责人:
John D Manning
金额:
$13.7万
依托单位国家:
美国
项目类别:
财政年份:
2023
资助国家:
美国
项目状态:
未结题
起止时间:
2023-09-01 至 2028-08-31
中文摘要
项目总结/文摘
英文摘要
Project Summary/Abstract
Rural Americans experiencing an ST-Elevation Myocardial Infarction (STEMI) are eight times less likely to
receive timely definitive treatment than their urban counterparts. This disparity exists even after percutaneous
coronary intervention (PCI) times are adjusted for distance to the hospital and exposes rural patients to excess
morbidity and mortality. A major obstacle to timely rural STEMI care is a lack of tools available to assist
paramedics in providing a consistent evidence-based approach to prehospital STEMI. Our proposal will
translate evidenced-based rural Emergency Medical Services (EMS) STEMI best practices into a multifaceted,
digital, clinical decision support tool to address this obstacle. This study builds on our team’s foundational
mixed methods research that identified (i) previously poorly quantified complexities of rural EMS STEMI care,
(ii) barriers to timely care, and (iii) opportunities for improvement. The Rural STEMI Application will be
developed, implemented, and refined using an open-source, cross-platform mobile application developed
internally by our team. Initially, we will develop and test the usability of the Rural STEMI App in a rural North
Carolina County EMS agency to improve prehospital providers’ ability to reduce first medical contact (FMC) to
reperfusion (PCI or thrombolytic) times. This will be the first smart device application to provide real-time,
evidence-based, guideline-driven, patient-specific treatment assistance for EMS patients with STEMI. We
anticipate that the final App will incorporate specific real-time data, including EMS arrival on scene, ECG time,
map integrations of nearby emergency departments and catheterization labs, and catheterization lab
availability. This novel digital tool will assist the EMS team by providing a scene time countdown, hospital
activation metric countdowns, and EMS-specific route navigation assistance to further decrease FMC to
reperfusion time. Thus, our application will incorporate critical parameters needed to predict FMC to
reperfusion time and identify patients that are better treated with initial thrombolytic administration instead of
PCI. Through phased implementation of the Rural STEMI App in seven additional rural EMS agencies, we will
evaluate its feasibility and preliminary effectiveness to reduce FMC to reperfusion time. This application will
also address the need for improved STEMI encounter communication by providing an automatically generated
STEMI feedback report to all key stakeholders. Finally, this proposed study will be the first to apply a mixed
methods approach to characterize implementation facilitators and barriers among rural EMS agencies in the
care they provide to STEMI patients. By engaging field providers in semi-structured interviews, the study will
emphasize quality improvement efforts, EMS administration support, and interdisciplinary collaboration in the
care of EMS patients with STEMI. This proposal directly addresses a critical gap regarding how to improve
rural prehospital FMC to reperfusion times, which in turn will reduce disparities in morbidity and mortality. We
will subsequently test the Rural STEMI App in a large multisystem hybrid effectiveness-implementation trial.
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