Mission: Lifeline

The AHA STEMI InitiativeStatus Report

Alice K. Jacobs, M.D.Boston University Medical Center

Boston, MA

There are no conflicts or relationships to disclose.

• Community-based National initiative

• Improve quality of care + outcomes in STEMI

• Improve health care system readiness and response to STEMI.

AHA’s STEMI Initiative

Mission: Lifeline

How do we increase the number of

patients with timely access to

primary PCI?

0

10

20

30

40

50

60

% o

f P

atie

nts

Distribution of Total Door-to-Balloon Time in Transfer Patients in NCDR 2005-06

< 1 2 to <3

Hours

Chakrabarti. JACC. 2008;51:2442-2443.

1 to <2 3 to <4 4 to <5 5 to <6 6 to <7 > 7

1.3

26.4

36.3

17.6

8.24.3

2.2 3.7

n=15,049 patients

n=491 hospitalsMedian D-to-B 152 min

< 90 min = 8.6%

• May 30, 2007 Conference Proceedings published in Circulation

and Mission: Lifeline Launched

ECCTask Force

Chair: Robert O'Conner,MD

Model EvaluationTask Force

Chair: Elliott Antman, MD

AdvisoryWorking Group

Chair: Alice Jacobs,MD

Administrative Structure

• Assess EMS Systems and Strategies for Improvement• Evaluate Existing Models• Establish Local Initiatives• Explore Possibility of National STEMI Certification

Elliott Antman, MDBob O’Conner, MDGray Ellrodt, MDNeil MeltzerBob Harrington, MDGeorge Mensah, MDEric Peterson, MDDavid Williams, MD

State Health Alliances

Cultural Health Initiatives ECC

State Advocacy

Quality Improvement Communications

AHA StaffMission: Lifeline

EMS System Assessment and Improvement

• The American Heart Association

is participating in a needs assessment in collaboration with EMS organizations

and is analyzing the effectiveness of EMS

for STEMI patients as part of a STEMI system of care.

Mission: Lifeline On-Line Survey

www.americanheart.org/missionlifeline

EMS Assessment for STEMI

• Designed for all EMS County organizations

• TEST Phase from May 12 through June 6, 2008 distributed by State Health Alliance staff in eight test states: CA, DE, KS, MO, NC, PA, TX, and WY

• After test phase, the assessment was distributed to all fifty states via NASEMSO and other EMS organizations.

Evaluate Existing Models

• The American Heart Association will review existing local or regional STEMI Systems of Care models.

- Administration - Locale (Urban, Rural)

- Processes of Care- Financial Considerations

- Disparities in care- Resource allocation

Have You Registered Your STEMI System

with Mission: Lifeline??

Have You Registered Your STEMI System with Mission: Lifeline?

www.americanheart.org/missionlifeline

Have You Registered Your STEMI System with Mission: Lifeline?

www.americanheart.org/missionlifeline

Establishing Local Initiatives

• The American Heart Association has

convened the task force initiative at the

state and local levels to identify ways

to implement national recommendations for STEMI systems in local communities.

Establishing Local Initiatives

• Patients and care givers

• Physicians, nurses and other providers

• Payers• EMS• PCI capable and non-

PCI capable hospitals

• Department of Health• Rural health

association• Quality improvement

organizations• State and local

policymakers

Task force members::

How will we measure our impact?

PCIPCIcapable

Non-PCINon-PCIcapable

SYSTEMSYSTEM OF CARE OF CARE

CENTER OF CENTER OF CARECARE

CENTER OF CENTER OF CARECARE

Patient

EMSED

STEMI Referral

STEMI Receiving

Policy Makers

Activate EMS

Avoid delay

12-lead ECG

9-1-1 interhospital transport

Activate team

No diversion

Consider integrated payment

No penalty to patients

Protocols and toolkits

STEMI Center Certification

Quality improvement measures

Treatment protocols and clinical pathways

Payer

Jacobs. Circulation 2007;116:217-230.

PCIcapable

Not PCIcapable

Patient

EMSED

STEMIReferral

Payers

Policy Makers STEMI

Receiving

NHAAP

CDC NAEMTNAEMSPNASEMSONEMSISACEPAmerican Ambulance AssnAACCNENA

ACTION/GWTG

NRHA

SCAI

Society of Chest Pain Centers

ACP

STS

AACCN

ENA

CMSAetna

UnitedHealth Networks

CMS

Center of Care

Adapted from Jacobs. Circulation 2007;116;217-230

Evaluation& Outcomes

AHRQ

FDA

JCAHO