Novel approach to evaluation of medical care quality delivered to patients with ST-segment elevation acute coronary syndrome: course to clinical result
Year: 2014, volume 10 Issue: №3 Pages: 408-413
Heading: Internal Diseases Article type: Author's opinion
Authors: Posnenkova О.М., Kiselev A.R., Popova Yu.V., Gridnev V.I., Dovgalevsky P.Ya., Danilov A.N.
Organization: Saratov Institute of Cardiology, Russia
Heading: Internal Diseases Article type: Author's opinion
Authors: Posnenkova О.М., Kiselev A.R., Popova Yu.V., Gridnev V.I., Dovgalevsky P.Ya., Danilov A.N.
Organization: Saratov Institute of Cardiology, Russia
Summary:
The purpose was to implement system analysis of clinical cases for development of healthcare quality indicators for STe-ACS patients, aimed at achievement of clinical result — decrease of in-hospital mortality. Mathehal and Methods. National recommendations on diagnostic and treatment of patients with myocardial infarction with ST-segment elevation on ECG (2007) were used to determine clinical result of treatment and key measures of medical care. To reveal major causes of clinical result non-achievement fishbone diagram was used. Results. Early reperfusion and optimal medical therapy were determined as the key measures of medical care delivered to patients with STe-ACS. The following indicators were developed to control these measures: «Primary reperfusion», «Thrombolysis in 30 minutes», «Primary percutaneous coronary intervention in 90 minutes», «Dual antiplatelet therapy in hospital», «Beta-blockers administration», «ACE-is/ARBs administration». The major causes of in-hospital mortality were separated. Indicators for assessment the major causes of clinical result non-achievement were proposed. Principal stages of performance measures creation were posed. Conclusion. Recommendation-based and clear definition of clinical result of treatment and key measures of the result achievement combined with methods of systems analysis allows development of evidence-based measures for assessment the quality of care delivered to patients with STe-ACS.
Keywords: ST-segment elevation acute coronary syndrome, quality indicators, quality assessment, medical care quality
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