Abstract 195: The Importance Of Assessing Inter-regional Systems Of Healthcare In Patients With ST-Elevation Myocardial Infarction (STEMI): Examples From A Systematic Field Evaluation
Notice bibliographique
Résumé
BACKGROUND: INESSS is a government-funded independent body that aids in evidence-based policy-making. Its cardiology evaluation unit recently completed a second systematic province-wide field evaluation of STEMI care in Quebec during a 6-month period in 2008-2009 in collaboration with a committee of clinical experts. The main objectives were to improve STEMI care by: 1) providing individual feedback to hospitals; and 2) identifying problems related to systems of STEMI care through analysis of inter-regional data. METHODS: At least 3 clinicians and 2 administrators of each of the 80 participating hospitals received a portrait of STEMI care for the province, their region and their hospital. Individual report cards ranked the healthcare region and the hospital for 14 measures of care. For the inter-regional analyses, we examined characteristics of existing networks of STEMI care such as the corridors of service for transfers for primary percutaneous coronary intervention (PPCI). RESULTS: At the provincial level, 82% of treated patients (n=1608) received PPCI. The majority (61%, n=987) were transferred from a non-tertiary centre with a median door-in door-out delay of 51 minutes (min) (10-90th percentile: 26-135) and a median door-to-device delay of 112 min (75-209). Notably, the 2 healthcare regions with the greatest number of STEMI patients had among the lowest proportions of patients treated (whether with PPCI or fibrinolysis) within recommended delays (39% and 32%, respectively). One of these regions had 9 community hospitals and a single PPCI center that did not have cardiac surgery-on-site (SOS) while the other region had 11 community hospitals and 6 PCI centers (1 no SOS and 5 SOS). In the latter region, >60% of STEMI patients had a direct admission PPCI but 3/6 centers had a median door-to-device time >90 min and there was a large variation in center volume. Only 22% of STEMI patients transferred for PPCI had a door-to device ≤90 min and choice of PPCI center was often not geographically optimal. Two PPCI centers received <5 transfers for PPCI. In the region with a single noSOS PPCI center, 76% of patients were transferred for PPCI but this center treated only 20% of these patients, 80% being sent to one of 4 PPCI centers in neighbouring regions. Only 19% of the transferred patients were treated ≤90 min, the median delay being 111 min (82-181). Sub-optimal utilization of the noSOS PPCI center in this region was also indicated by the low prevalence of direct admission PPCI (21%) compared with 2 other regions that had a single PPCI center (42% and 48%, respectively). CONCLUSIONS: Our province-wide evaluation of STEMI care indicates that it is important to examine systems of care as well as in-hospital processes. In 2 poorly-performing but high-output regions of Quebec, transfer for PPCI was the predominant choice of treatment of the community hospitals despite long delays. Moreover, recourse to certain PPCI centers appeared to be sub-optimal for both direct admission PPCI and transfer for PPCI. Thus, to improve systems of STEMI care, healthcare organizers must identify ways to optimize both choice of reperfusion strategy and corridors of service.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,491 | 0,601 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,007 |
| Bibliométrie | 0,010 | 0,012 |
| Études des sciences et des technologies | 0,002 | 0,004 |
| Communication savante | 0,009 | 0,006 |
| Science ouverte | 0,003 | 0,005 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».