Comparing the Process of Quality of Care for Managing Acute ST-Segment Elevation Myocardial Infarction between Headquarter and Branch Hospitals

Ying-Hsian Chen ； Jou-Wei Lin ； Sheng-Nan Chang ； Juey-Jen Hwang

《Acta Cardiologica Sinica》 24卷3期 (2008/09) Pp. 121-125

並列摘要

Background: Based on internationally accepted guidelines, management of acute ST-segment elevation myocardial infarction (STEMI) must follow a discrete discipline and can be used as an indicator for monitoring quality of care (QC). The objective of this study was to apply a standardized measurement to evaluate QC for STEMI between headquarter and a branch hospital so as to maintain QC during expansion of a health care organization in Taiwan.
Methods: All the patients presented to National Taiwan University Hospital Yun-Lin Branch (NTUH-YL) with STEMI between 1st December 2004 and 30(superscript th) November 2006 were reviewed retrospectively. Overall one-year mortality rate and ten parameters related to the process of QC for STEMI were retrieved and compared to those from National Taiwan University Hospital (NTUH).
Results: During the period, 74 patients manifested with STEMI to NTUH-YL, with mean age 59+/-12 in men and 69+/-11 in women. One-year overall mortality was 8~10% in both hospitals. In comparing the performance, NTUH-YL was superior in β-blocker use and lipid management, and inferior in early aspirin use. Other parameters such as reperfusion rate, complication rates, use of angiotensin-converting enzyme inhibitors, and long-term aspirin use were comparable between headquarter and branch hospitals.
Conclusion: Less-experienced cardiologists can perform equally well and even better than more-experienced doctors if principles of evidence-based medicine are applied. Measurements in the process domain can be used to compare and to ensure quality of care across different health providers.

並列關鍵字

Aspirin ； HMG-CoA ； Myocardial infarction ； Percutaneous transluminal coronary angioplasty ； Quality of health care ； Statins