[A database in the coronary care unit to assess quality of care of acute myocardial infarction].
BACKGROUND
In the context of an operative network for acute coronary syndrome consisting in telemedicine equipment and 24-h catheter facility availability, a database was worked out to verify clinical pathways, timeline, prevalence of cardiovascular risk factors, diagnostic and therapeutic choices, and clinical results. The aim of this study was to evaluate the adherence to guidelines in the real world in order to assess quality of care.


METHODS
We implemented a database in the preexisting hospital intranet due to open source interactive pages. From international guidelines we obtained performance measures for each step of the care process, in order to have a continuous and updated evaluation of our healthcare performance. After an accurate analysis of the results of the first 2-year data collection, we modified the performance measurement set to optimize our database. All data were analyzed with statistical program SPSS.


RESULTS
A total of 1066 patient characteristics within a period of 5 semesters were analyzed: trends for each of the 11 performance measures were evaluated. In 852 patients clinical and angiographic characteristics were analyzed: cardiovascular risk factors and TIMI risk score for ST-elevation myocardial infarction patients, different pathways and first-aid timeline. Data about pharmacological therapy on admission, during intensive care unit stay and at discharge were also collected.


CONCLUSIONS
The present study assesses the utility of continuous monitoring and of verifying quality of care with a dedicated database in order to evaluate adherence to guidelines and to promote optimization of clinical practice.
Izzo
Antonio
A
Dipartimento di Cardiologia, Ospedale Carlo Poma, Mantova. cardiomantova@virgilio.it
Tomasi
Luca
L
Lettieri
Corrado
C
Agostini
Francesco
F
Ferrari
Maria Rosa
MR
Aroldi
Marco
M
Mantovani
Paola
P
Bonatti
Silvia
S
Zanini
Roberto
R
D000368:Aged; D003195:Computer Communication Networks; D003325:Coronary Care Units; D016208:Databases, Factual; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D011787:Quality of Health Care