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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

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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

  • Improve quality of care + outcomes in STEMI

  • Improve health care system readiness and response to STEMI.



Distribution of Total Door-to-Balloon Time in Transfer Patients in NCDR 2005-06

n=15,049 patients

n=491 hospitals

Median D-to-B 152 min

< 90 min = 8.6%

36.3

26.4

17.6

8.2

4.3

3.7

2.2

1.3

< 1

1 to <2

3 to <4

5 to <6

4 to <5

6 to <7

2 to <3

> 7

Hours

Chakrabarti. JACC. 2008;51:2442-2443.


  • May 30, 2007 Patients in NCDR 2005-06

  • Conference Proceedings published in Circulation and Mission: Lifeline Launched


Administrative Structure Patients in NCDR 2005-06

Elliott Antman, MD

Bob O’Conner, MD

Gray Ellrodt, MD

Neil Meltzer

Bob Harrington, MD

George Mensah, MD

Eric Peterson, MD

David Williams, MD

  • Assess EMS Systems and Strategies for Improvement

  • Evaluate Existing Models

  • Establish Local Initiatives

  • Explore Possibility of National STEMI Certification


Aha staff
AHA Staff Patients in NCDR 2005-06

Mission: Lifeline

State Health Alliances

State Advocacy

Quality Improvement

Communications

Cultural Health Initiatives

ECC


EMS System Assessment and Improvement Patients in NCDR 2005-06

  • 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.


Mission lifeline on line survey
Mission: Lifeline On-Line Survey Patients in NCDR 2005-06

www.americanheart.org/missionlifeline


Ems assessment for stemi

Designed for all EMS County organizations Patients in NCDR 2005-06

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.

EMS Assessment for STEMI


Evaluate Existing Models Patients in NCDR 2005-06

Have You Registered Your STEMI System with Mission: Lifeline??

  • 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
Have You Registered Your STEMI System with Mission: Lifeline?

www.americanheart.org/missionlifeline


Have you registered your stemi system with mission lifeline1
Have You Registered Your STEMI System with Mission: Lifeline?

www.americanheart.org/missionlifeline


Establishing Local Initiatives Lifeline?

  • 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.


Establishing local initiatives

Patients and care givers Lifeline?

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

Establishing Local Initiatives

Task force members:



Non-PCI Lifeline?

capable

PCI

capable

Activate EMS

Avoid delay

Patient

Consider integrated payment

No penalty to patients

12-lead ECG

9-1-1 interhospital transport

Payer

EMSED

Activate team

No diversion

STEMI

Referral

SYSTEM OF CARE

CENTER OF CARE

Treatment protocols and clinical pathways

Policy

Makers

STEMI

Receiving

CENTER OF CARE

Protocols and toolkits

STEMI Center Certification

Quality improvement measures

Jacobs. Circulation 2007;116:217-230.


Not PCI Lifeline?

capable

NHAAP

CDC

Patient

NAEMT

NAEMSP

NASEMSO

NEMSIS

ACEP

American Ambulance Assn

AACCN

ENA

CMS

Aetna

UnitedHealth Networks

Payers

EMSED

AHRQ

FDA

JCAHO

Evaluation

& Outcomes

STEMIReferral

ACTION/GWTG

NRHA

SCAI

Society of Chest Pain Centers

ACP

STS

AACCN

ENA

Policy Makers

Center of Care

STEMIReceiving

PCI

capable

CMS

Adapted from Jacobs. Circulation2007;116;217-230


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