title: [Quality indicators for the assessment of ST-segment elevation acute myocardial infarction (STEMI) networks. How hospital discharge records could be integrated with Emergency medical services data: the Emilia-Romagna STEMI network experience].
abstract: BACKGROUND
  The assessment of the regional network for ST-segment elevation acute myocardial infarction (STEMI) is fundamental for quality assurance. Since 2011 all Italian Health Authorities, in addition to hospital discharge records (HDR), must provide a standardized information flow (ERD) about emergency department (ED) and emergency medical system (EMS) activities. The aim of this study was to evaluate whether data integration of ERD with HDR may allow the development of appropriate quality indicators.
  
  
  METHODS
  Patients admitted to coronary care units (CCU) for STEMI between January 1 to December 31, 2013, were identified from the regional HDR database. All data were linked to those of the regional ERD database. Four quality indicators were defined: 1) rates of EMS activation, 2) rates of EMS direct transfer to the catheterization laboratory (Cath-lab), 3) transfer rates from a Spoke to a Hub hospital with angioplasty facilities, and 4) median time spent in ED.
  
  
  RESULTS
  In 2013, 2793 patients with STEMI were admitted to the CCU. Of these, 1684 patients (60%) activated EMS and were transported to Spoke or Hub hospitals; 955 (57%) entered directly in CCU/Cath-lab; 677 were transferred directly to a Hub hospital ED without being admitted to a Spoke hospital. The median ED time in Hub hospital was 47 min (IQR 24-136) and in Spoke hospital 53 min (IQR 30-131).
  
  
  CONCLUSIONS
  The integration among administrative data banks (i.e., HDR with ERD) allowed the assessment of the regional STEMI network and the identification of potentially useful quality indicators. Their easy availability should enable comparisons with local, national and international standards, and may favor quality improvement.
authors.affiliation: U.O.C. Cardiologia, Ospedale Maggiore, Bologna.
authors.forename: Pier Camillo
authors.initials: PC
authors.lastname: Pavesi
authors.affiliation: Agenzia Sanitaria e Sociale Emilia-Romagna.
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.affiliation: U.O.C. Cardiologia, Ospedale Maggiore, Bologna.
authors.forename: Gianni
authors.initials: G
authors.lastname: Casella
authors.affiliation: Agenzia Sanitaria e Sociale Emilia-Romagna.
authors.forename: Elena
authors.initials: E
authors.lastname: Berti
authors.affiliation: Agenzia Sanitaria e Sociale Emilia-Romagna.
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: Agenzia Sanitaria e Sociale Emilia-Romagna - U.O. Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Udine.
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Bartolomeo
authors.affiliation: U.O.C. Cardiologia, Ospedale Maggiore, Bologna.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Pasquale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003325:Coronary Care Units; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D010351:Patient Discharge / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors