title: Impact of a statewide ST-segment-elevation myocardial infarction regionalization program on treatment times for women, minorities, and the elderly.
abstract: BACKGROUND
  Prior studies have demonstrated differences in time to reperfusion for ST-segment-elevation myocardial infarction (STEMI) in women, minorities, and the elderly, relative to their counterparts. Regionalization has been shown to improve overall STEMI treatment times, but its impact on care differences among these important patient subgroups is unknown. The objective of this analysis was to assess the impact of a statewide system of STEMI care (The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments) on treatment times according to patient sex, race, and age.
  
  
  RESULTS
  STEMI treatment times were determined before (July 2005 to September 2005) and after (January 2007 to March 2007) a year-long implementation of coordinated regional treatment protocols. Times in the pre- and postintervention periods were compared by mixed-effects models. A total of 2063 STEMI patients were analyzed: 1140 at percutaneous coronary intervention hospitals and 923 at non-percutaneous coronary intervention hospitals. The Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments was associated with significant improvements in treatment times in women and the elderly, including door-to-ECG, door-to-device, door-in-door-out, and door-to-needle times (all P<0.05). Temporal improvements in treatment times at percutaneous coronary intervention hospitals were not significantly different in blacks than in whites. There was a reduction in baseline treatment disparities in door-to-ECG times in women versus men (4.4-minute reduction in difference; 95% CI, -8.1 to -0.4; P=0.03). After Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments, an age-treatment time gap persisted in the elderly, relative to younger patients.
  
  
  CONCLUSIONS
  A statewide STEMI regionalization program was associated with comparable improvement in treatment times for female, black, and elderly patients compared with middle-aged, white male patients. Nevertheless, there remain opportunities to further narrow treatment differences, particularly among the elderly.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27599, USA. swglick@med.unc.edu
authors.forename: Seth W
authors.initials: SW
authors.lastname: Glickman
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Fang-Shu
authors.initials: FS
authors.lastname: Ou
authors.forename: Sean
authors.initials: S
authors.lastname: O'Brien
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.forename: Charles B
authors.initials: CB
authors.lastname: Cairns
authors.forename: Greg
authors.initials: G
authors.lastname: Mears
authors.forename: James W
authors.initials: JW
authors.lastname: Hoekstra
authors.forename: J Lee
authors.initials: JL
authors.lastname: Garvey
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D004562:Electrocardiography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000503:physiopathology; D009657:North Carolina; D013221:State Health Plans; D013997:Time Factors; D014930:Women