[Evidence of healthcare quality improvement in acute myocardial infarction].
BACKGROUND
The monitoring of healthcare quality indicators (HCQI) is a process of utmost importance in patient healthcare services.


OBJECTIVE
To evaluate whether the monitoring of HCQI and the root-cause analysis improve the healthcare quality in acute myocardial infarction (AMI).


METHODS
A cross-sectional and comparative analysis of HCQI was performed in patients with AMI in the years 2006 and 2007. Of the 1,461 patients admitted with chest pain, 172 (11.7%) had a diagnosis of AMI and were included in the analysis.


RESULTS
The rate of primary angioplasty was 8.47% higher in 2007 (97.3%) when compared to that in 2006 (89.7%), but this difference was not statistically significant (p = 0.35). Moreover, there was no difference regarding the time of hospitalization (4 vs 5 days, p = 0.15) and the in-hospital mortality (7.8% vs 5.1%, p = 0.67) between 2007 and 2006, respectively. However, the time to the first troponin level was 27% shorter in 2007 (69 min.; 95%CI = 44-94 min.) when compared to 2006 (95 min.; 53-136 min.) (p = 0.025). The door-to-balloon time was 12% shorter (72 +/- 29 min. vs 109 +/- 85 min.; p = 0.03), the rate of ASA prescription at hospital discharge was 35% higher (94.7% vs 70.3%; p = 0.002) and the rate of PCA shorter than 90 minutes was 52% higher (78.3 vs 51.4%; p = 0.03) in 2007, when compared to 2006.


CONCLUSIONS
Our results suggest that the strategy of monitoring the HCQI and the implementation of the root-cause analysis methodology can improve the healthcare process in patients with AMI.
Rocha
Antônio Sérgio Cordeiro da
AS
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brasil. ntqa@procardiaco.com.br
Araújo
Mônica Peres de
MP
Volscham
André
A
Carvalho
Luiz Antonio Ferreira
LA
Ribeiro
Ary
A
Mesquita
Evandro Tinoco
ET
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome