mission: lifeline the aha stemi initiative status report alice k. jacobs, m.d
DESCRIPTION
Mission: Lifeline The AHA STEMI Initiative Status Report Alice K. Jacobs, M.D. Boston University Medical Center Boston, MA There are no conflicts or relationships to disclose. AHA’s STEMI Initiative Mission: Lifeline. Community-based National initiative - PowerPoint PPT PresentationTRANSCRIPT
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Mission: Lifeline
The AHA STEMI InitiativeStatus Report
Alice K. Jacobs, M.D.Boston University Medical Center
Boston, MA
There are no conflicts or relationships to disclose.
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• Community-based National initiative
• Improve quality of care + outcomes in STEMI
• Improve health care system readiness and response to STEMI.
AHA’s STEMI Initiative
Mission: Lifeline
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How do we increase the number of
patients with timely access to
primary PCI?
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0
10
20
30
40
50
60
% o
f P
atie
nts
Distribution of Total Door-to-Balloon Time in Transfer Patients in NCDR 2005-06
< 1 2 to <3
Hours
Chakrabarti. JACC. 2008;51:2442-2443.
1 to <2 3 to <4 4 to <5 5 to <6 6 to <7 > 7
1.3
26.4
36.3
17.6
8.24.3
2.2 3.7
n=15,049 patients
n=491 hospitalsMedian D-to-B 152 min
< 90 min = 8.6%
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• May 30, 2007 Conference Proceedings published in Circulation
and Mission: Lifeline Launched
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ECCTask Force
Chair: Robert O'Conner,MD
Model EvaluationTask Force
Chair: Elliott Antman, MD
AdvisoryWorking Group
Chair: Alice Jacobs,MD
Administrative Structure
• Assess EMS Systems and Strategies for Improvement• Evaluate Existing Models• Establish Local Initiatives• Explore Possibility of National STEMI Certification
Elliott Antman, MDBob O’Conner, MDGray Ellrodt, MDNeil MeltzerBob Harrington, MDGeorge Mensah, MDEric Peterson, MDDavid Williams, MD
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State Health Alliances
Cultural Health Initiatives ECC
State Advocacy
Quality Improvement Communications
AHA StaffMission: Lifeline
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EMS System Assessment and Improvement
• The American Heart Association
is participating in a needs assessment in collaboration with EMS organizations
and is analyzing the effectiveness of EMS
for STEMI patients as part of a STEMI system of care.
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Mission: Lifeline On-Line Survey
www.americanheart.org/missionlifeline
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EMS Assessment for STEMI
• Designed for all EMS County organizations
• TEST Phase from May 12 through June 6, 2008 distributed by State Health Alliance staff in eight test states: CA, DE, KS, MO, NC, PA, TX, and WY
• After test phase, the assessment was distributed to all fifty states via NASEMSO and other EMS organizations.
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Evaluate Existing Models
• The American Heart Association will review existing local or regional STEMI Systems of Care models.
- Administration - Locale (Urban, Rural)
- Processes of Care- Financial Considerations
- Disparities in care- Resource allocation
Have You Registered Your STEMI System
with Mission: Lifeline??
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Have You Registered Your STEMI System with Mission: Lifeline?
www.americanheart.org/missionlifeline
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Have You Registered Your STEMI System with Mission: Lifeline?
www.americanheart.org/missionlifeline
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Establishing Local Initiatives
• The American Heart Association has
convened the task force initiative at the
state and local levels to identify ways
to implement national recommendations for STEMI systems in local communities.
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Establishing Local Initiatives
• Patients and care givers
• Physicians, nurses and other providers
• Payers• EMS• PCI capable and non-
PCI capable hospitals
• Department of Health• Rural health
association• Quality improvement
organizations• State and local
policymakers
Task force members::
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How will we measure our impact?
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PCIPCIcapable
Non-PCINon-PCIcapable
SYSTEMSYSTEM OF CARE OF CARE
CENTER OF CENTER OF CARECARE
CENTER OF CENTER OF CARECARE
Patient
EMSED
STEMI Referral
STEMI Receiving
Policy Makers
Activate EMS
Avoid delay
12-lead ECG
9-1-1 interhospital transport
Activate team
No diversion
Consider integrated payment
No penalty to patients
Protocols and toolkits
STEMI Center Certification
Quality improvement measures
Treatment protocols and clinical pathways
Payer
Jacobs. Circulation 2007;116:217-230.
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PCIcapable
Not PCIcapable
Patient
EMSED
STEMIReferral
Payers
Policy Makers STEMI
Receiving
NHAAP
CDC NAEMTNAEMSPNASEMSONEMSISACEPAmerican Ambulance AssnAACCNENA
ACTION/GWTG
NRHA
SCAI
Society of Chest Pain Centers
ACP
STS
AACCN
ENA
CMSAetna
UnitedHealth Networks
CMS
Center of Care
Adapted from Jacobs. Circulation 2007;116;217-230
Evaluation& Outcomes
AHRQ
FDA
JCAHO