title: Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline.
abstract: BACKGROUND
  National guidelines call for participation in systems to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States.
  
  
  RESULTS
  A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association Mission: Lifeline website. Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%).
  
  
  CONCLUSIONS
  This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI.
authors.affiliation: Duke University Medical Center, Durham, NC, USA. james.jollis@duke.edu
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.forename: Peter H
authors.initials: PH
authors.lastname: Moyer
authors.forename: Franklin D
authors.initials: FD
authors.lastname: Pratt
authors.forename: Ivan C
authors.initials: IC
authors.lastname: Rokos
authors.forename: Anna R
authors.initials: AR
authors.lastname: Acuña
authors.forename: Mayme Lou
authors.initials: ML
authors.lastname: Roettig
authors.forename: Alice K
authors.initials: AK
authors.lastname: Jacobs
mesh_terms: D000572:American Heart Association; D015906:Angioplasty, Balloon, Coronary / Q000191:economics / Q000592:standards*; D016507:Cardiology Service, Hospital / Q000191:economics / Q000592:standards*; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards*; D004632:Emergency Medical Services / Q000191:economics / Q000592:standards*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D007373:Interinstitutional Relations; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards*; D010343:Patient Admission / Q000592:standards; D010348:Patient Care Team / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012040:Regional Health Planning / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States