texas regional stemi system of care report · introduction ... during the 83rd regular texas...

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2016 TEXAS REGIONAL STEMI SYSTEM OF CARE REPORT Regional Advisory Council (RAC)

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Table of Contents

Executive Summary ....................................................................................................................................... 2

Introduction .................................................................................................................................................. 3

Background ................................................................................................................................................... 3

Introduction to STEMI System of Care: ..................................................................................................... 3

Methodology ................................................................................................................................................. 4

Data Analysis ................................................................................................................................................. 6

Results ........................................................................................................................................................... 6

Total Number of Confirmed STEMI Cases: ................................................................................................ 6

Arrival Method for Confirmed STEMI Cases: ............................................................................................. 8

Total Confirmed STEMI Cases Transferred for PCI to a STEMI Receiving Hospital: ................................ 13

Primary PCI within 120 Minutes of Arrival at the STEMI Referral Hospital among STEMI Transfers: .... 15

Door in Door out (DIDO) time less than 30 Minutes at STEMI Referral Hospital for STEMI Transfers: .. 17

Thrombolytic Therapy as an Urgent Treatment at STEMI Referral Hospital among total confirmed STEMI Cases: ........................................................................................................................................... 19

Thrombolysis within 30 Minutes of Arrival at STEMI Referral Hospital among STEMI Cases that received Thrombolytic Therapy: .............................................................................................................. 21

Health Insurance among Reported STEMI Cases: ................................................................................... 23

Conclusions ................................................................................................................................................. 25

Limitations: ................................................................................................................................................. 25

Appendix A .................................................................................................................................................. 26

Appendix B .................................................................................................................................................. 27

Appendix C .................................................................................................................................................. 28

Appendix D .................................................................................................................................................. 29

Appendix E .................................................................................................................................................. 30

Appendix F .................................................................................................................................................. 31

References .................................................................................................................................................. 38

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Executive Summary

• The total confirmed STEMI cases (8,664) used for the final analysis were included from RAC Data Survey and NCDR-ACTION Registry GWTG between July 1, 2015 and June 30, 2016. 85.8% of the total STEMI cases were included from RAC Data Survey and 14.2% of the total STEMI cases were included from GWTG registry.

• OSER analyzed data from NCDR-ACTION Registry GWTG for the RACs ‘E’, ‘H’, ‘K’, ‘L’, ‘N’, ‘O’,’P’, ‘Q’ and ‘V’ to fill the gaps for analysis. We identified hospitals from GWTG registry that were not participating in RAC Data Survey and included them in the analysis.

• Among directly admitted and not a transfer STEMI cases, a median of 38.6% and an average of 36.5% arrived at the hospital by an EMS / Ambulance.

• Among directly admitted and not a transfer STEMI cases, a median of 37.6% and an average of 38.3% arrived at the hospital by a private transportation.

• Among STEMI transfer cases, a median of 16.8% and an average of 16.2% arrived at the STEMI referral hospital via different modes of transportation.

• An average of 26.2% and a median of 27.2% of the total confirmed STEMI cases were transferred for a PCI to a STEMI receiving hospital. RAC ‘E’ reported highest number of STEMI cases transferred for PCI to a STEMI receiving hospital with a total count of 472.

• Among the STEMI cases that were transferred for a PCI to a STEMI receiving hospital, a median of 40.0% and an average of 43.3% received PCI within 120 minutes of arrival at STEMI referral hospital.

• The total number of STEMI cases that were transferred for a PCI to a STEMI receiving hospital were 1,759. And among 1,759 STEMI transfer cases, 189 (14.1%) had a door in and door (DIDO) out time less than 30 minutes at STEMI referral hospital. There is a huge opportunity for quality improvement of DIDO times at STEMI referral hospitals.

• An average of 11.0% and a median of 8.5% received thrombolytic treatment as an urgent treatment at STEMI referral hospital among the total confirmed STEMI cases (8,664).

• The total number of STEMI cases that received thrombolytic treatment as an urgent treatment at STEMI referral hospital were 610. And among these 610 STEMI cases, 296 cases received thrombolysis within 30 minutes of arrival at a STEMI referral hospital. So an average of 51.8% and a median of 48.7% received thrombolysis within 30 minutes of arrival at a STEMI referral hospital.

• Among the total confirmed STEMI cases (8,664), an average of 55.7% had any health insurance, 15.1% didn’t have any health insurance and 15.5% had health insurance not documented or unknown.

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Introduction Heart Disease and Stroke are the number one and number three leading causes of death in Texas, respectively in 2014.¹ In order to advance reduction in death and disability, it is important to analyze the current state of systems of care for both conditions by collecting and analyzing data. During the 83rd Regular Texas Legislative Session, funds were appropriated to advance heart attack and stroke reduction efforts throughout Texas. To inform such efforts, the Texas Department of State Health Services (DSHS) has launched a heart attack and stroke data collection initiative. The data collection initiative focuses on pre-hospital and hospital heart attack and stroke data elements from multiple sources for comprehensive assessment of systems of care for heart attack and stroke. The purpose of data collection among the Regional Advisory Councils (RACs) is to enhance surveillance of the Stroke and STEMI systems of care in Texas. Survey findings will be used to assess policies and practices regarding delivery of Stroke and STEMI care across the state and identify areas of opportunity for quality improvement. RACs will collect and report data to the Health Promotion and Chronic Disease Prevention Section (HPCDPS) of DSHS and HPCDPS will analyze the data and report results of the analyses to RACs and the Texas Council on Cardiovascular Disease and Stroke (TXCVDS), as well as other stakeholders.

Background With guidance from the Texas Council on Cardiovascular Disease and Stroke, Governor’s EMS and Trauma Advisory Council (GETAC), and the Texas Department of State Health Services (DSHS) Office of Surveillance, Evaluation and Research (OSER), the Texas Heart Disease and Stroke Program developed an online survey using Survey Monkey (https://www.surveymonkey.com) to gather pre-hospital and hospital Stroke and STEMI regional data.

The 22 Regional Advisory Councils (RACs) were surveyed and asked to report Stroke and STEMI data elements for their regions, also known as Trauma Service Area (TSA), that occurred from July 1, 2015 to June 30, 2016. RACs collected and reported data to the Health Promotion and Chronic Disease Prevention Section (HPCDPS) of DSHS and OSER analyzed the data and created this report to inform RACs and the Texas Council on Cardiovascular Disease and Stroke, as well as other stakeholders.

Figure 1 (Appendix A) shows the geographic coverage of the 22 RACs in Texas, all of which were represented in the survey.

Introduction to STEMI System of Care: RACS were asked to report on eight data elements related to the STEMI system of care including the number of confirmed STEMI cases in the RAC.

Hospitals are considered PCI-capable if they have a catheterization lab that is available 24 hours a day and are able to perform percutaneous coronary interventions (PCIs). Figure 2 (Appendix B) displays the PCI-capable hospitals in Texas. There are gaps in PCI capability across the state, primarily in the western and southern regions, and primarily rural areas. Table 1 includes the approximate number of PCI-capable facilities by TSA⁴.

https://www.surveymonkey.com/

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Table 1: Number of PCI-Capable Hospitals by TSA

TSA Total Number of PCI-Capable Hospitals A 2 B 2 C 1 D 2 E 44 F 2 G 3 H 4 I 6 J 2 K 2 L 3 M 2 N 2 O 14 P 16 Q 30 R 8 S 2 T 1 U 2 V 6

Total 154 • There are 15 RACs with five or fewer PCI-capable hospitals.

Methodology This report includes the de-identified, aggregate RAC-level data collected from hospitals who agreed to share hospital-level data through the RAC Data Surveys. This report also includes de-identified, aggregate data for hospitals who have agreed to share National Cardiovascular Data Registry’s (NCDR®) Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry®-GWTG™ (Get with the Guidelines) -STEMI data with DSHS. All data is protected under Health Insurance Portability Accountability Act (HIPAA) guidelines. No hospital-level data will be distributed, nor will any hospital name be identified in the report.

RACs collected data from the regional hospitals via the semi-annual survey and submitted aggregate data to DSHS. There were a total of 24 questions in the survey, consisting of the following elements: RAC leadership and contact information, pre-hospital and hospital elements of Stroke and STEMI data (Appendix F). RAC Data Survey 1, collected data on cases that occurred between July 1, 2015 and December 31, 2015. RAC Data Survey 2, collected data on cases that occurred between January 1, 2016

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and June 30, 2016. The surveys’ RAC-level data submitted to OSER was subsequently combined for analysis and includes data reported from July 1, 2015 through June 30, 2016.

OSER identified hospitals participating in the NCDR®-ACTION Registry® GWTG™ registry that did not provide hospital-level data through the RAC Data Surveys. These hospitals’ data from July 1, 2015 to June 30, 2016 were analyzed at the regional level and aggregate data were added to the RAC-level data collected through the RAC Data Surveys.

The Figure-6 explains the data collection method and analysis process used for the evaluation of the STEMI system of care at the regional level.

Figure 6: Flow Chart explaining the methodology and analysis used for preparing RAC data reports

RAC Data Collection (via semi-annual surveys)

Hospitals participating

in GWTG and with

DSHS

Hospitals participating in GWTG but

not with DSHS

Hospitals NOT

participating in either GWTG or

DSHS

Aggregate data from the hospitals will be collected by each RAC. The list of hospitals submitted data to RACs will be available with the aggregate data.

RACs submit aggregate data to

DSHS

RAC Data Reports (format word documents and

dashboard for individual RACs)

Identify hospitals from GWTG data that are not included in RACs

data by each RAC

Pull data for these hospitals at RAC level

Analyze data from the above subset for the measures included in RAC

survey following the same definitions given to RACs

Add aggregate data to each RAC

RAC Data Reports Method and Process

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Data Analysis OSER cleaned the data to remove duplicate entries before analyzing the data. The RACS were followed up when clarification was needed. RAC Data Survey was analyzed using Microsoft Excel 2010, and GWTG data was analyzed using SAS 9.4.

The measures and values reported represent aggregate RAC-level data and do not represent individual hospital performance. The results in this report represent only who responded to the surveys and may not be generalizable to the state of Texas.

Results Total Number of Confirmed STEMI Cases: The total number of confirmed STEMI cases from RAC Data Survey between July 1, 2015 and June 30, 2016 was 7,434. The number of STEMI cases analyzed from NCDR-ACTION Registry GWTG hospitals which didn’t participate in RAC Data Survey during the same time frame were 1,230. OSER added the data from the RAC survey and the GWTG registry and the total STEMI cases (8,664) were used for the final analysis.

• 85.8% of the total confirmed STEMI cases used for the final analysis were included from RAC Data Survey and 14.2% of the STEMI cases were collected from NCDR ACTION Registry GWTG.

• The number of STEMI cases reported from RAC Data Survey ranged from as low as 50 for RAC ‘C’ to as high as 2,394 for RAC ‘Q’.

• From the NCDR- ACTION Registry GWTG, the STEMI cases were collected from RACs ‘E’, ‘H’, ‘K’, ‘L’, ‘N’, ‘O’,’P’, ‘Q’ and ‘V’ to fill the gaps for analysis. The STEMI Cases ranged from as low as 10 in RAC ‘V’ to as high as 599 in RAC ‘E’.

• The total number of STEMI cases in the final analysis ranged from as low as 50 in RAC ‘C’ to as high as 2,429 in RAC ‘Q’.

• The number of reporting hospitals were calculated in each survey by adding the number of hospitals reported through RAC Data Survey and the number of hospitals reported through NCDR- ACTION Registry GWTG.

• The number of reporting hospitals ranged from as low as 2 for RAC ‘T’ to as high as 42 for RAC ‘E’.

• The number of eligible hospitals ranged from 2 in RAC ‘T’ to 83 in RAC ‘E’. The number of eligible hospitals’ list is collected between September 1, 2015 and August 30, 2016. The difference in the time frame between the eligible hospitals’ list and RAC level analysis might explain slighter higher number of reporting hospitals than eligible hospitals for RACS ‘M’ and ‘N’.

• RAC ‘L’ didn’t report any number of confirmed STEMI cases and subsequent questions during RAC Survey -1.

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Table 2. Total number of confirmed STEMI cases from July 1, 2015 through June 30, 2016 by RACs.

RAC RAC Data Survey

NCDR-ACTION Registry GWTG

Total STEMI Cases

Reporting Hospitals (both RAC and GWTG)

Number of Eligible Hospitals

Survey 1 Survey 2 Total n= 7,434 n= 1,230 n = 8,664 A 204 -- 204 12 13 18 B 139 -- 139 16 16 18 C 50 -- 50 3 5 13 D 203 -- 203 16 9 17 E 1,180 599 1,779 42 34 83 F 130 -- 130 4 6 6 G 433 -- 433 8 7 21 H 76 73 149 5 8 8 I 198 -- 198 6 6 9 J 236 -- 236 12 11 17 K 103 23 126 8 10 10 L 129 86 215 3 7 10 M 211 -- 211 7 8 7 N 143 55 198 9 9 8 O 185 16 201 4 8 26 P 485 333 818 10 17 36 Q 2,394 35 2,429 35 34 54 R 235 -- 235 7 6 18 S 123 -- 123 4 6 7 T 71 -- 71 2 2 2 U 240 -- 240 3 4 11 V 266 10 276 5 11 13

‘--‘missing values

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Figure 7. Total number of confirmed STEMI cases from July 1, 2015 through June 30, 2016 by RACs.

Arrival Method for Confirmed STEMI Cases: The preferred method of treatment for STEMI patients is Percutaneous Coronary Insertion (PCI) where a stent is inserted in to the blocked artery that stopped supplying blood to the heart. The catheter through percutaneous access is used to guide the stent and place it in to the blocked artery. There are PCI capable hospitals (also called STEMI receiving hospitals) and non-PCI capable hospitals (also called STEMI referring hospitals). The patients who were transported directly to PCI capable hospitals through private transport, ambulance and mobile or air are referred in this report as directly admitted STEMI patients. The patients who were transferred from non-PCI capable hospital to PCI capable hospital are referred as transfer patients. The mode of arrival refers to the method of transportation to the first hospital.

The summation of STEMI cases by their modes of transportation should be less than or equal to the total number of confirmed STEMI cases. When the sum of STEMI cases by their arrival mode was higher than the total number of confirmed STEMI cases reported by the RACs in either of the two RAC Data Surveys, they were removed from the analysis for that question. This was the case with RACs ‘E’, ‘G’, ‘Q’, ‘R’, ‘U’ and ‘V’.

0

500

1000

1500

2000

2500

3000

A B C D E F G H I J K L M N O P Q R S T U V

Repo

rted

STE

MI C

ases

RACs

RAC Data Survey NCDR-ACTION Registry

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Table 3: Arrival method for confirmed STEMI cases

--‘Missing values; ‘---‘Missing values entered as a result of errors submitted to RAC Data Survey

‘R’ = RAC, ‘G’ =GWTG, ‘T’ = Total, ‘P’= Percent, ‘S1’ = Survey 1, ‘S2’ = Survey 2, ‘E.H’ = Eligible Hospitals

RAC Total STEMI Cases

Number arriving via EMS/ambulance AND not a transfer

Number arriving via private transportation/walk in/family/self AND not a transfer

Number arriving via other transport (mobile ICU or air) AND not a transfer

Number arriving via transfer. Transfer mode may include ambulance, mobile ICU, air transport, or unknown. (can include transfers to a STEMI referral hospital)

Number with arrival mode not documented or unknown AND not a transfer

Reporting Hospitals

E.H

R G T P R G T P R G T P R G T P R G T P S 1 S 2 Total n=

8,664 n =

963 n= 233

n = 1,196

36.5% n = 943

n = 206

n = 1,149

38.3% n =56

n = 9

n = 65

2.6% n = 447

n = 137

n = 584

17.2% n = 86

n = 0

n = 86

5.2%

A 204 30 -- 30 14.7% -- -- -- -- 8 -- 8 3.9% 69 -- 69 33.8% -- -- -- -- 12 13 18 B 139 37 -- 37 26.6% 52 -- 52 37.4% -- -- -- -- 39 -- 39 28.1% 8 -- 8 5.8% 16 16 18 C 50 18 -- 18 36.0% 27 -- 27 54.0% -- -- -- -- -- -- -- -- 1 -- 1 2.0% 3 5 13 D 203 47 -- 47 23.2% 60 -- 60 29.6% 20 -- 20 9.9% 47 -- 47 23.2% 1 -- 1 0.5% 16 9 17 E 1,779 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 83 F 130 59 -- 59 45.4% 37 -- 37 28.5% 2 -- 2 1.5% 22 -- 22 16.9% -- -- -- -- 4 6 6 G 433 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 21 H 149 23 20 43 28.9% 42 37 79 53.0% -- 2 2 1.3% 10 14 24 16.1% 1 -- 1 0.7% 5 8 8 I 198 107 -- 107 54.0% 88 -- 88 44.4% -- -- -- -- 3 -- 3 1.5% -- -- -- -- 6 6 9 J 236 63 -- 63 26.7% 89 -- 89 37.7% 2 -- 2 0.8% 25 -- 25 10.6% 41 -- 41 17.4% 12 11 17 K 126 22 6 28 22.2% 33 6 39 31.0% 2 -- 2 1.6% 15 11 26 20.6% 29 -- 29 23.0% 8 10 10 L 215 52 30 82 38.1% 39 35 74 34.4% 1 4 5 2.3% 36 16 52 24.2% 1 -- 1 0.5% 3 7 10 M 211 86 -- 86 40.8% 89 -- 89 42.2% -- -- -- -- 35 -- 35 16.6% -- -- -- -- 7 8 7 N 198 57 32 89 44.9% 65 20 85 42.9% 1 1 2 1.0% 20 2 22 11.1% -- -- -- -- 9 9 8 O 201 91 8 99 49.3% 72 2 74 36.8% 3 -- 3 1.5% 14 6 20 10.0% 1 -- 1 0.5% 4 8 26 P 818 183 137 320 39.1% 189 106 295 36.1% 12 2 14 1.7% 82 88 170 20.8% 1 -- 1 0.1% 10 17 36 Q 2,429 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 54 R 235 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 18 S 123 51 -- 51 41.5% 32 -- 32 26.0% 2 -- 2 1.6% 29 -- 29 23.6% 2 -- 2 1.6% 4 6 7 T 71 37 -- 37 52.1% 29 -- 29 40.8% 3 -- 3 4.2% 1 -- 1 1.4% -- -- -- -- 2 2 2 U 240 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 11 V 276 --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- --- 13

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Figure 8 shows the percentage of directly admitted STEMI cases arriving by an EMS/Ambulance to the hospital at each of the RACs.

• The median percent is 38.6% for the STEMI cases arriving at the hospital by an EMS/ Ambulance. • RAC ‘I’ reported the highest percent of the STEMI cases (54.0%) arriving at the hospital by an

EMS /Ambulance. • RAC ‘A’ reported the lowest percent of the STEMI cases (14.7%) arriving at the hospital by an

ambulance. RAC ‘A’ has missing values for mode of arrival in RAC survey-1 which may be the reason for low percentage.

Figure 8: Percentage of STEMI Cases arriving via EMS/Ambulance and not a transfer

36.5%

14.7%

26.6%

36.0%

23.2%

45.4%

28.9%

54.0%

26.7%22.2%

38.1%40.8%

44.9%49.3%

39.1% 41.5%

52.1%

0%

10%

20%

30%

40%

50%

60%

Perc

enta

ge o

f STE

MI C

ases

RACs

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Figure 9 shows the percentage of directly admitted STEMI Cases arriving via private transportation to the hospital at each of the RACs.

• The median percent is 37.6% for the STEMI cases arriving at the hospital via private transportation.

• RAC ‘S’ has the lowest percent of the STEMI Cases (26.0%) arriving at the hospital via private transportation.

• RAC ‘C’ has the highest percent of the STEMI Cases (54.0%) arriving at the hospital via private transportation.

Figure 9: Percentage of STEMI Cases arriving via Private Transportation and not a transfer

38.3% 37.4%

54.0%

29.6% 28.5%

53.0%

44.4%

37.7%

31.0%34.4%

42.2% 42.9%36.8% 36.1%

26.0%

40.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Perc

enta

ge o

f STE

MI C

ases

RACs

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Figure 10 shows the percentage of STEMI transfer cases arriving via different modes of transportation to the hospital at each of the RACs.

• The median percent is 16.8% for the STEMI cases arriving at the STEMI receiving hospital via transfer.

• RAC ‘T’ has the lowest percent of the STEMI cases (1.4%) arriving at the STEMI receiving hospital via transfer.

• RAC ‘A’ has the highest percent of the STEMI cases (33.8%) arriving at the STEMI receiving hospital via transfer.

Figure 10: Percentage of STEMI Cases arriving via transfer (Different Modes of Transportation or Unknown)

16.2%

33.8%

28.1%

0.0%

23.2%

16.9% 16.1%

1.5%

10.6%

20.6%24.2%

16.6%

11.1%10.0%

20.8%23.6%

1.4%0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Perc

enta

ge o

f STE

MI C

ases

RACs

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Total Confirmed STEMI Cases Transferred for PCI to a STEMI Receiving Hospital: Figure 11 and Table 4 below show the confirmed STEMI cases transferred for PCI to a PCI capable hospital from a non-PCI capable hospital.

• The highest number of STEMI cases transferred for a PCI to a STEMI receiving hospital were reported by RAC ‘E’ with a total count of 472.

• However, the percentage of STEMI cases transferred for a PCI to a STEMI receiving hospital was highest for RAC ‘B’ with 75.5%.

• The median percent of STEMI cases transferred for a PCI to a STEMI receiving hospital was 27.2%

• The RACs ‘H’, ‘I’, ‘Q’, ‘R’ and ‘T’ didn’t report the number of STEMI cases transferred for PCI during survey -1 which may be the reason for lower final total.

• The number of reporting hospitals ranged from 2 in RAC ‘T’ to 42 in RAC ‘E’.

Figure 11: Percentage of confirmed STEMI cases transferred for PCI treatment to a STEMI receiving hospital

26.2%19.6%

75.5%

42.0%35.5%

26.5%

13.8%

30.0%

14.8%

1.5%

31.8%34.1%

17.7%

29.4%

46.0%

17.4%

27.9%

4.4% 4.3%

41.5%

16.9%14.2%

32.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Perc

enta

ge o

f STE

MI C

ases

tran

sfer

red

for P

CI

RACs

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Table 4: Total number of confirmed STEMI cases transferred for percutaneous coronary intervention (PCI) treatment to a STEMI receiving hospital.

RAC Total STEMI Cases Total number of confirmed STEMI cases transferred for percutaneous coronary intervention (PCI) treatment to a STEMI receiving hospital. Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent that presented to a STEMI referral hospital first and then were transferred to a STEMI receiving hospital where they received PCI. Transfer mode may include ambulance, mobile ICU, air transport, or unknown.

Reporting hospitals (both RAC and GWTG)


RAC GWTG Total Percent survey 1

survey 2

Total n = 8,664 n = 1,526 n = 233 n = 1,759 26.2% A 204 40 -- 40 19.6% 12 13 18 B 139 105 -- 105 75.5% 16 16 18 C 50 21 -- 21 42.0% 3 5 13 D 203 72 -- 72 35.5% 16 9 17 E 1,779 376 96 472 26.5% 42 34 83 F 130 18 -- 18 13.8% 4 6 6 G 433 130 -- 130 30.0% 8 7 21 H 149 8 14 22 14.8% 5 8 8 I 198 3 -- 3 1.5% 6 6 9 J 236 75 -- 75 31.8% 12 11 17 K 126 32 11 43 34.1% 8 10 10 L 215 22 16 38 17.7% 3 7 10 M 211 62 -- 62 29.4% 7 8 7 N 198 89 2 91 46.0% 9 9 8 O 201 29 6 35 17.4% 4 8 26 P 818 140 88 228 27.9% 10 17 36 Q 2,429 108 -- 108 4.4% 35 34 54 R 235 10 -- 10 4.3% 7 6 18 S 123 51 -- 51 41.5% 4 6 7 T 71 12 -- 12 16.9% 2 2 2 U 240 34 -- 34 14.2% 3 4 11 V 276 89 -- 89 32.2% 5 11 13


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Primary PCI within 120 Minutes of Arrival at the STEMI Referral Hospital among STEMI Transfers:

• Figure 12 and Table 5 show that RAC ‘M’ has the highest percentage (95.2%) of the reported STEMI transfers that received primary PCI within 120 minutes of arrival at STEMI referral hospital.

• The median percent of the reported STEMI transfers that received PCI within 120 minutes of arrival at STEMI referral hospital was 40.0%

• RAC ‘G’ reported higher number of STEMI transfers with PPCI less than 120 minutes than the reported number of STEMI transfers in RAC Data Survey – 2. Hence, we reported missing values for RAC ‘G’.

• The number of reporting hospitals ranged from 2 for RAC ‘L’ to 33 for RACs ’E’ and ‘Q’.

Figure 12: Primary PCI within 120 minutes of arrival at the STEMI referral hospital

43.3%

27.5%

55.2%

4.8%1.4%

74.8%

27.8%

13.6%

33.3%

10.7%

53.5%44.7%

95.2%

18.7%

88.6%

34.2%

49.1%40.0% 39.2%

75.0%

52.9%

68.5%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Perc

ent o

f STE

MI t

rans

fers

with

PPC

I w

ithin

120

Min

RACs

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Table 5: Primary PCI within 120 Minutes of Arrival at the STEMI Referral Hospital among STEMI Transfers:

RAC Reported STEMI Transfers

Of the STEMI transfers reported, how many received primary PCI within 120 minutes of arrival at the STEMI referral hospital? Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent that presented to a STEMI referral hospital first and then were transferred to a STEMI receiving hospital where they received PCI within 120 minutes of arrival to the STEMI referral hospital. It uses time elapsed from arrival at the STEMI referral hospital to receipt of primary percutaneous coronary intervention at the STEMI receiving hospital to calculate time from first door to balloon.



RAC GWTG Total Percent survey 1 survey 2 Total n = 1,759 n =688 n = 143 n = 831 43.3% A 40 11 -- 11 27.5% 12 13 18 B 105 58 -- 58 55.2% 16 16 18 C 21 1 -- 1 4.8% 3 5 13 D 72 1 -- 1 1.4% 16 9 17 E 472 302 51 353 74.8% 33 27 83 F 18 5 -- 5 27.8% 4 6 6 G 130 --- --- --- --- --- --- 21 H 22 -- 3 3 13.6% 4 7 8 I 3 1 -- 1 33.3% 6 6 9 J 75 8 -- 8 10.7% 12 11 17 K 43 14 9 23 53.5% 8 10 10 L 38 12 5 17 44.7% 2 7 10 M 62 59 -- 59 95.2% 7 8 7 N 91 17 -- 17 18.7% 8 8 8 O 35 25 6 31 88.6% 4 8 26 P 228 9 69 78 34.2% 8 16 36 Q 108 53 -- 53 49.1% 33 31 54 R 10 4 -- 4 40.0% 7 6 18 S 51 20 -- 20 39.2% 4 6 7 T 12 9 -- 9 75.0% 2 2 2 U 34 18 -- 18 52.9% 3 4 11 V 89 61 -- 61 68.5% 4 11 13

‘--‘Missing values; ‘---‘Missing values entered as a result of errors submitted to RAC Data Survey

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Door in Door out (DIDO) time less than 30 Minutes at STEMI Referral Hospital for STEMI Transfers:

• Among a total of 1,759 reported STEMI transfer cases, 189 cases (14.1%) had door in and door out time less than 30 minutes at STEMI referral hospital.

• The median percent was 12.0% for STEMI transfer cases that had a door in and door out time less than 30 minutes at STEMI referral hospital.

• RAC ‘G’ has the highest percent of STEMI cases (35.4%) with a door in and door out time less than 30 minutes.

• RAC ‘J’ has the lowest percent of STEMI cases (1.3%) with a door in and door out time less than 30 minutes.

• The number of reporting hospitals ranged from 2 for RAC ‘T’ to 35 for RAC ‘E’.

Figure 13: Percentage of STEMI cases with Door in Door out (DIDO) time less than 30 Minutes at STEMI referral hospital for STEMI transfers

14.1%

2.5%

9.5%

0.0%0.0%

8.3%5.6%

35.4%33.3%

1.3%

20.9%

10.5%

4.8%

19.8%

25.7%

12.0%

21.6%25.0%

14.7%16.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Perc

enta

ges

of S

TEM

I tra

nsfe

rs w

ith

DIDO

< 3

0 m

in

RACs

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Table 6: Door in Door out (DIDO) time less than 30 Minutes at STEMI Referral Hospital for STEMI Transfers:

RAC Reported STEMI Transfers

Total number of confirmed STEMI cases transferred for percutaneous coronary intervention (PCI) treatment that had a door in door out (DIDO) time of less than 30 minutes at STEMI referral facility.



RAC GWTG Total Percent survey 1 survey 2 Total n = 1,759 n = 189 n = 0 n = 189 14.1% A 40 1 -- 1 2.5% 12 13 18 B 105 10 -- 10 9.5% 16 16 18 C 21 -- -- -- -- 3 5 13 D 72 -- -- -- -- 16 9 17 E 472 39 -- 39 8.3% 35 28 83 F 18 1 -- 1 5.6% 4 6 6 G 130 46 -- 46 35.4% 8 7 21 H 22 -- -- -- -- 5 7 8 I 3 1 -- 1 33.3% 6 6 9 J 75 1 -- 1 1.3% 12 11 17 K 43 9 -- 9 20.9% 8 10 10 L 38 4 -- 4 10.5% 3 7 10 M 62 3 -- 3 4.8% 7 8 7 N 91 18 -- 18 19.8% 9 9 8 O 35 9 -- 9 25.7% 4 8 26 P 228 -- -- -- -- 8 16 36 Q 108 13 -- 13 12.0% 33 31 54 R 10 -- -- -- -- 7 6 18 S 51 11 -- 11 21.6% 4 6 7 T 12 3 -- 3 25.0% 2 2 2 U 34 5 -- 5 14.7% 3 4 11 V 89 15 -- 15 16.9% 4 11 13


19

Thrombolytic Therapy as an Urgent Treatment at STEMI Referral Hospital among total confirmed STEMI Cases:

• Table 7 shows that among a total of 8,664 confirmed STEMI cases, 571 from RAC Data Survey and 39 from GWTG registry received thrombolytic therapy as an urgent treatment at STEMI referral hospital. An average of 11.0% of those cases received thrombolytic therapy among total reported STEMI cases.

• The median was 8.5% for the confirmed STEMI cases that received thrombolytic therapy as an urgent treatment at STEMI referral hospital.

• RAC ‘C’ reported highest percentage of cases (38.0%) with thrombolytic treatment among total confirmed STEMI cases.

• RAC ‘B’ reported 36.7% of cases with thrombolytic treatment among total confirmed STEMI cases.

• RACs ‘A’,’H’, ‘I’, ‘L’, ‘M’, ‘Q’, ‘R’ and ‘V’ have missing values for the question during RAC survey-1. Hence, low percentages are observed for these RACs.

• For RAC ‘E’, among a total of 1,779 confirmed STEMI cases, 33 cases received thrombolytic treatment (1.9%). The number of reporting hospitals is 35 for survey-1 and 28 for survey-2. There are 83 eligible hospitals in RAC ‘E’.

Figure 14: Percentage of Confirmed STEMI Cases with Thrombolytic Therapy as an Urgent Treatment at STEMI Referral Hospital

11.0%9.3%

36.7%38.0%

23.6%

1.9%

6.2%

12.7%14.1%

0.5%

9.7%10.3%

5.1%

0.9%

7.6%

0.0%

23.2%

0.7%1.3%

1.6%

8.5%

28.3%

1.8%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Perc

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EMI C

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RACs

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Table 7: Thrombolytic Therapy as an Urgent Treatment at STEMI Referral Hospital among total confirmed STEMI Cases:


Of the total STEMI cases reported, how many received thrombolytic therapy as an urgent treatment for STEMI at STEMI referral hospital? Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent, who received thrombolytic therapy as an urgent treatment for STEMI at a STEMI referral hospital. Include any occurrence between first medical contact and discharge.



RAC GWTG Total Percent survey 1 survey 2 n =

8,664 n = 571 n = 39 n = 610 11.0%

A 204 19 -- 19 9.3% 12 13 18 B 139 51 -- 51 36.7% 16 16 18 C 50 19 -- 19 38.0% 3 5 13 D 203 48 -- 48 23.6% 16 9 17 E 1,779 18 15 33 1.9% 35 28 83 F 130 8 -- 8 6.2% 4 6 6 G 433 55 -- 55 12.7% 8 7 21 H 149 16 5 21 14.1% 5 7 8 I 198 1 -- 1 0.5% 6 6 9 J 236 23 -- 23 9.7% 12 11 17 K 126 11 2 13 10.3% 8 10 10 L 215 6 5 11 5.1% 3 7 10 M 211 2 -- 2 0.9% 7 8 7 N 198 14 1 15 7.6% 9 9 8 O 201 -- -- -- -- 4 8 26 P 818 179 11 190 23.2% 8 16 36 Q 2,429 17 -- 17 0.7% 33 31 54 R 235 3 -- 3 1.3% 7 6 18 S 123 2 -- 2 1.6% 4 6 7 T 71 6 -- 6 8.5% 2 2 2 U 240 68 -- 68 28.3% 3 4 11 V 276 5 -- 5 1.8% 4 11 13


21

Thrombolysis within 30 Minutes of Arrival at STEMI Referral Hospital among STEMI Cases that received Thrombolytic Therapy:

• Table 8 below shows that among a total of 610 STEMI cases that received thrombolytic therapy, 296 received thrombolytic therapy within 30 minutes of arrival at STEMI referral hospital (51.8%).

• The median percent was 48.7% among STEMI cases that received thrombolysis within 30 minutes of arrival at STEMI referral hospital.

• Among a total of 190 STEMI cases that received thrombolytic therapy for RAC ‘P’, 103 cases (54.2%) received thrombolytic therapy within 30 minutes of arrival at STEMI referral hospital.

• The number of reporting hospitals ranged from 2 for RAC ‘T’ to 33 for RAC ‘Q’.

Figure 15: Thrombolysis within 30 Minutes of Arrival at STEMI Referral Hospital among STEMI Cases that received Thrombolytic Therapy

51.8%47.4%

64.7%

36.8%27.1%

69.7%

37.5%27.3%

57.1%

100.0%

30.4%

84.6%90.9%

33.3%

0.0%

54.2%47.1%

100.0%

50.0%50.0%

39.7%40.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

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30

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22

Table 8: Thrombolysis within 30 Minutes of Arrival at STEMI Referral Hospital among STEMI Cases that received Thrombolytic Therapy:

RAC STEMI Cases that received Thrombolytic Therapy

Of the STEMI cases that received thrombolytic therapy, how many received therapy within 30 minutes of arrival at STEMI referral hospital? Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent, who received thrombolytic therapy within 30 minutes as an urgent treatment for STEMI at STEMI referral hospital. Include any occurrence between first medical contact and discharge.



RAC GWTG Total Percent survey 1 survey 2 Total n = 610 n = 260 n = 36 n = 296 51.8% A 19 9 -- 9 47.4% 12 13 18 B 51 33 -- 33 64.7% 16 16 18 C 19 7 -- 7 36.8% 3 5 13 D 48 13 -- 13 27.1% 16 9 17 E 33 9 14 23 69.7% 30 20 83 F 8 3 -- 3 37.5% 4 6 6 G 55 15 -- 15 27.3% 8 7 21 H 21 7 5 12 57.1% 4 7 8 I 1 1 -- 1 100.0% 6 6 9 J 23 7 -- 7 30.4% 12 11 17 K 13 9 2 11 84.6% 8 10 10 L 11 5 5 10 90.9% 2 7 10 M 2 -- -- -- -- 7 8 7 N 15 5 -- 5 33.3% 8 8 8 O -- -- -- -- -- 3 8 26 P 190 93 10 103 54.2% 4 14 36 Q 17 8 -- 8 47.1% 33 31 54 R 3 3 -- 3 100.0% 7 6 18 S 2 1 -- 1 50.0% 4 6 7 T 6 3 -- 3 50.0% 2 2 2 U 68 27 -- 27 39.7% 3 4 11 V 5 2 -- 2 40.0% 4 11 13


23

Health Insurance among Reported STEMI Cases: Table 9 shows that among a total of 8,664 confirmed STEMI cases, an average of 55.7% had any health insurance, 15.1% didn’t have any health insurance and 15.5% had health insurance not documented or unknown.

• RAC ‘O’ has the highest percent (87.1%) of STEMI cases with any health insurance. • RAC ‘L’ has 81.4% of STEMI cases with any health insurance. • RACs ‘A’, ‘D’, ‘L’,’Q’, ’R’ and ’V’ didn’t report any values for this question during RAC survey -1.

And RAC ’M’ didn’t report any values for this question in both the RAC surveys. Hence we have missing values for RAC ‘M’.

• RAC ‘C’ has the highest percentage of STEMI cases (32.0%) without any health insurance. • RAC ‘I’ has the highest percentage of STEMI cases (58.6%) with health insurance not

documented or unknown. • The number of reporting hospitals ranged from 2 in RAC ‘T’ to 42 in RAC ‘E’.

Figure 16: Percentage of STEMI Cases with Health Insurance

Figure 17: Percentage of STEMI Cases without Health Insurance

55.7%

33.8%

79.9%68.0%

5.9%

66.9%

43.1%55.4%

71.8%

33.8%

74.6%

43.7%

81.4%

52.5%

87.1%

72.2%

37.1%39.1%

61.0%73.2%

35.8%

54.3%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Perc

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RACs

15.1%

7.4%

18.7%

32.0%

1.0%

15.0%16.2%

21.9%23.5%

7.6%

19.1%

10.3%

18.1% 19.2%

12.9%15.2%

9.5%11.5%

9.8%

25.4%

6.3%

15.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

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24

Table 9: Health Insurance among Reported STEMI Cases:



Number with any health insurance Number without health insurance Number with health insurance not documented or unknown.

Reporting hospitals

Eligible Hospitals

RAC GWTG Total Percent RAC GWTG Total Percent RAC GWTG Total Percent survey 1

survey 2

Total n = 8,664

n = 3,511 n=1,006 n = 4,517

55.7% n =899 n=224 n=1,123 15.1% n =463 n =0 n=463 15.5%

A 204 69 -- 69 33.8% 15 -- 15 7.4% -- -- -- -- 12 13 18 B 139 111 -- 111 79.9% 26 -- 26 18.7% 2 -- 2 1.4% 16 16 18 C 50 34 -- 34 68.0% 16 -- 16 32.0% -- -- -- -- 3 5 13 D 203 12 -- 12 5.9% 2 -- 2 1.0% 43 -- 43 21.2% 16 9 17 E 1,779 689 501 1,190 66.9% 169 98 267 15.0% 100 -- 100 5.6% 42 34 83 F 130 56 -- 56 43.1% 21 -- 21 16.2% 53 -- 53 40.8% 4 6 6 G 433 240 -- 240 55.4% 95 -- 95 21.9% 53 -- 53 12.2% 8 7 21 H 149 58 49 107 71.8% 11 24 35 23.5% -- -- -- -- 5 8 8 I 198 67 -- 67 33.8% 15 -- 15 7.6% 116 -- 116 58.6% 6 6 9 J 236 176 -- 176 74.6% 45 -- 45 19.1% 2 -- 2 0.8% 12 11 17 K 126 36 19 55 43.7% 9 4 13 10.3% 32 -- 32 25.4% 8 10 10 L 215 101 74 175 81.4% 27 12 39 18.1% -- -- -- -- 3 7 10 M 211 -- -- -- -- -- -- -- -- -- -- -- -- 7 8 7 N 198 65 39 104 52.5% 22 16 38 19.2% 8 -- 8 4.0% 9 9 8 O 201 161 14 175 87.1% 24 2 26 12.9% -- -- -- -- 4 8 26 P 818 319 272 591 72.2% 63 61 124 15.2% 1 -- 1 0.1% 10 17 36 Q 2,429 870 30 900 37.1% 225 5 230 9.5% 16 -- 16 0.7% 35 34 54 R 235 92 -- 92 39.1% 27 -- 27 11.5% -- -- -- -- 7 6 18 S 123 75 -- 75 61.0% 12 -- 12 9.8% 36 -- 36 29.3% 4 6 7 T 71 52 -- 52 73.2% 18 -- 18 25.4% 1 -- 1 1.4% 2 2 2 U 240 86 -- 86 35.8% 15 -- 15 6.3% -- -- -- -- 3 4 11 V 276 142 8 150 54.3% 42 2 44 15.9% -- -- -- -- 5 11 13

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Conclusions • Among directly admitted STEMI patients, an average of 36.5% arrived at the hospital by an EMS /

ambulance. Efforts should be taken to educate the public about the importance of arriving at the hospital via EMS/ambulance for possible heart attack cases.

• Among directly admitted STEMI patients, the average percent of STEMI cases arriving at the hospital via private transportation (38.3%) is greater than the average percent arriving via EMS/ambulance (36.5%).

• An average of 26.2% of confirmed STEMI cases were transferred for PCI treatment to a STEMI receiving hospital. Among these cases, an average of 43.3% received primary PCI within 120 minutes of arrival at the STEMI referral hospital. An average of 14.1% had a door in door out (DIDO) time less than 30 minutes at STEMI referral hospital.

• Among all the confirmed STEMI cases, an average of 11.0% received thrombolytic treatment as an urgent treatment at STEMI referral hospital. Among these cases, an average of 51.8% received thrombolysis within 30 minutes of arrival at STEMI referral hospital.

• An average of 55.7% of the confirmed STEMI cases had any form of health insurance.

Limitations: • Several RACs did not submit complete data for every data element that was requested,

especially for survey one (July 1, 2015 – December 1, 2015). In order to gain an accurate understanding of the systems of care, it is important to have complete data.

• The accuracy of the hospital-level data collected by the RAC affects the accuracy of the final aggregate RAC-level data submitted to DSHS. If the data submitted by an individual hospital to the RAC has an error or is incomplete, the aggregated RAC level data will carry that limitation and DSHS did not have scope to identify and eliminate that completely.

• The hospitals included in the data collection and the total number of reporting hospitals differs between survey one and survey two, as well as each measure. Because the data received by DSHS is aggregated at the RAC-level, there is no way to know which hospitals reported on which specific measures.

• There are STEMI receiving hospitals and STEMI referral hospitals in the analyses. The results can be overestimated in certain circumstances when both the STEMI referral hospitals and STEMI receiving hospitals submitted data to the RAC and NCDR®- ACTION Registry® GWTG™ program. Since the data are reported in aggregate form, DSHS did not have scope to de-duplicate if any cases are reported by both STEMI receiving hospitals and STEMI referral hospitals.

• The eligible hospitals can be both PCI capable and non-PCI capable hospitals. The list is created from DSHS list, RAC list and AHA list of hospitals. We have excluded children’s hospitals, orthopedic, cancer, surgical hospitals and acute and long-term care hospitals.

26

Appendix A

Figure 1: Map of Trauma Service Areas with RAC names, October 2006

Source: Office of EMS/ Trauma Systems, Jan 2010

Mapped by GIS Staff, Center for Health Statistics, May 2010

27

Appendix B

Figure 2: Map of PCI-Capable hospitals in Texas, October 2014

Source: www.heart.org/missionlifeline

http://www.heart.org/missionlifeline

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Appendix C

Figure 3: Map of total confirmed STEMI cases from July 1, 2015 through June 30, 2016 by RACs.

29

Appendix D

Figure 4: Map of total confirmed STEMI cases arriving via EMS / Ambulance and not a transfer from July 1, 2015 through June 30, 2016 by RACs.

30

Appendix E

Figure 5: Map of total confirmed STEMI cases with any Health Insurance from July 1, 2015 through June 30, 2016 by RACs.

31

Appendix F

Rider 97 RAC Data Survey #1 2016-03-01

Introduction

Stroke and STEMI Data Collection

The purpose of data collection among the Regional Advisory Councils (RACs) is to enhance surveillance of the stroke and STEMI systems of care in Texas. RACs will collect and report data to the Health Promotion and Chronic Disease Prevention Section (HPCDPS) of DSHS and HPCDPS will analyze the data and report results of the analyses to RACs and the Texas Council on Cardiovascular Disease and Stroke, as well as other stakeholders.

DSHS is asking RAC (leadership, RAC Chairs or RAC Directors and, if applicable, Stroke Committee Chairs and Cardiac Committee Chairs, or others) to work with key stakeholders in their regions to complete this survey. Information must be entered into every field to move forward to the next question. If your response to a question is a zero (0), please enter "0" in the text box. If you are not able to provide a response or compile the necessary data, please enter "NA" in the text box. Please provide the most accurate and complete data as possible.

This survey is due March 1, 2016, and should only include data from July 1, 2015, through December 31, 2015. If you have any questions about taking the survey, please contact Randy Crutsinger at 512-776-6525 or [email protected].

Thank you in advance for your time.

mailto:[email protected]

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RAC Information

1. RAC Information

RAC Name:

Trauma Service Area:

2. Person entering data

Name: Email Address:

Phone Number:

3. Your Professional Title:

4. I am the: RAC Chair RAC Executive Director

Stroke Committee Chair

Cardiac Committee Chair

Other (Please Specify)

33


Regional Hospital STEMI Data

Please consult the hospitals in your Trauma Service Area to enter the following data.

INCLUSION CRITERIA: Number of cases with ECG findings that demonstrated a STEMI or STEMI equivalent that presented to the emergency department during the corresponding months regardless of admission or transfer status.

NOTE: STEMI or STEMI equivalent must be noted prior to any procedures and not more than 24 hours after arrival at first facility. Arrival at first facility refers to either the time of arrival at your facility or the time of arrival at the transferring facility

5. Total number of confirmed STEMI cases from July 1, 2015 through December 31,2015.

34

6. Arrival method for the confirmed STEMI cases reported in Item 5.

Logic: 6a + 6b + 6c + 6d + 6e must be less than or equal to Item 5.

6a. Number arriving via EMS/ambulance AND not a transfer

6b. Number arriving via private transportation/walk in/family/self AND not a transfer

6c. Number arriving via other transport (mobile ICU or air) AND not a transfer

6d. Number arriving via transfer. Transfer mode may include ambulance, mobile ICU, air transport, or unknown. (can include transfers to a STEMI referral hospital)

6e. Number with arrival mode not documented or unknown AND not a transfer

7. Total number of confirmed STEMI cases transferred for percutaneous coronary intervention (PCI) treatment to a STEMI receiving hospital.

Definition: Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent that presented to a STEMI referral hospital first and then were transferred to a STEMI receiving hospital where they received PCI. Transfer mode may include ambulance, mobile ICU, air transport, or unknown.

Logic: Must be a number less than or equal to Item 5

35

8. Of the STEMI transfers reported in Item 7, how many received primary PCI within 120 minutes of arrival at the STEMI referral hospital?

Definition: Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent that presented to a STEMI referral hospital first and then were transferred to a STEMI receiving hospital where they received PCI within 120 minutes of arrival to the STEMI referral hospital. Please use time elapsed from arrival at the STEMI referral hospital to receipt of primary percutaneous coronary intervention at the STEMI receiving hospital to calculate time from first door to balloon.


9. Total number of confirmed STEMI cases transferred for percutaneous coronary intervention (PCI) treatment that had a door in door out (DIDO) time of less than 30 minutes at STEMI referral facility.


10. Of the STEMI cases reported in Item 5, how many received thrombolytic therapy as an urgent treatment for STEMI at STEMI referral hospital?

Definition: Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent, who received thrombolytic therapy as an urgent treatment for STEMI at a STEMI referral hospital. Include any occurrence between first medical contact and discharge.


11. Of the STEMI cases reported in Item 10, how many received thrombolytic therapy within 30 minutes of arrival at STEMI referral hospital?

Definition: Number includes all cases with ECG findings that demonstrate a STEMI or STEMI equivalent, who received thrombolytic therapy within 30 minutes as an urgent treatment for STEMI at STEMI referral hospital. Include any occurrence between first medical contact and discharge.


36

12. Indicate the health insurance status for cases with confirmed STEMI or STEMI equivalent.

Logic: 12a + 12b + 12c must be less than or equal to Item 5.

12a. Number with any health insurance

12b. Number without health insurance

12c. Number with health insurance not documented or unknown.

13. Please provide a list of individual hospital names that contributed to the STEMI data.

Please separate individual hospital names with a semicolon (;). If the individual hospital is part of a hospital system please use the following naming convention: Hospital System name - individual hospital name or location.

37


Thank You For Your Time

Thank you for completing this assessment of the STEMI and stroke systems of care in your Trauma Service Area. This information will assist Texas organizations in providing leadership, technical assistance, training, and additional resources to areas where system building is needed.

38

References

1. Texas Department of State Health Services, Vital Statistics Annual Report, Table 16, Leading Causes of Death (Total) Texas, 2014. Accessed at https://www.dshs.texas.gov/chs/vstat/vs14/t16.aspx

2. Texas EMS & Trauma Registries (2014) Texas Department of State Health Services.

3. American Heart Association. (2014) Mission: Lifeline directory. Retrieved from www.heart.org/missionlifeline.

4. Heart Attack and Stroke Data Collection Initiative, Regional Advisory Council Heart Attack and Stroke Data Report, May 2015

https://www.dshs.texas.gov/chs/vstat/vs14/t16.aspx

http://www.heart.org/missionlifeline

texas regional stemi system of care report · introduction ... during the 83rd regular texas...

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