Organization of care for acute myocardial infarction in rural and urban hospitals in Kansas.
BACKGROUND
One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined.


METHODS
Using a nominal group process, key elements within hospitals that might influence quality of AMI care were identified, including personnel, equipment, organizational systems, and quality improvement activities. These elements were included in a survey of 45 rural and 12 urban Kansas hospitals.


RESULTS
Though emergency 911 systems were widely available in both urban and rural communities, paramedics and advanced cardiac life support were less likely to be available in rural communities. Few rural hospitals were capable of emergent catheterization, angioplasty, or coronary artery bypass surgery; cardiologists, though readily available by phone, were rarely available on-site. Nevertheless, most rural ambulances could not bypass local hospitals. Most rural hospitals transferred the vast majority of their patients to urban medical centers within an average distance of 78 miles. Standardized protocols were used for emergent AMI care in 67% of urban and 62% of rural hospitals. Hospitals included aspirin in 53% and beta-blockers in 28% of either protocols or standing orders.


CONCLUSIONS
Although faced with more limited resources, some rural hospitals, like their urban counterparts, have implemented protocols to address emergent care of AMI patients. Nevertheless, many of these protocols omit crucial aspects of AMI care. Rural and urban hospitals should jointly develop systems that assure consistent, rapid delivery of AMI care.
Ellerbeck
Edward F
EF
Departments of Preventive Medicine and Internal Medicine, University of Kansas School of Medicine, Kansas City, KS 66160-7313, USA. eellerbe@kumc.edu
Bhimaraj
Arvind
A
Perpich
Denise
D
D016507:Cardiology Service, Hospital / Q000592:standards*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000592:standards*; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010360:Patient Transfer / Q000458:organization & administration; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D012041:Regional Medical Programs; D012307:Risk Factors; D013997:Time Factors