title: Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing.
abstract: BACKGROUND
  Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group).
  
  
  METHODS
  Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.
  
  
  RESULTS
  Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI: 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI: 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI: 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI: 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI: 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group.
  
  
  CONCLUSIONS
  Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.
authors.affiliation: The 28th Division, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
authors.forename: Li
authors.initials: L
authors.lastname: Song
authors.forename: Hong-bing
authors.initials: HB
authors.lastname: Yan
authors.forename: Da-yi
authors.initials: DY
authors.lastname: Hu
authors.forename: Jin-gang
authors.initials: JG
authors.lastname: Yang
authors.forename: Yi-hong
authors.initials: YH
authors.lastname: Sun
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002681:China; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011787:Quality of Health Care; D015912:Thrombolytic Therapy