Dose Reducing Door-to-balloon Time in ST-elevation Myocardial Infarction Cause Less Cost?

Acute STEMI Clinical Trial

Official title:

Better Quality With Less Cost? A Single Hospital Experience on Reducing Door-to-balloon Time in ST-elevation Myocardial Infarction

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01545206
• Other study ID #: 100046-E
• Status: Completed
• Phase: N/A
• First received: March 1, 2012
• Last updated: March 5, 2012
• Start date: February 1997
• Est. completion date: July 2010

Study information

• Verified date: March 2012
• Source: Far Eastern Memorial Hospital
• Contact: n/a
• Is FDA regulated: No
• Health authority: Taiwan: Institutional Review Board
• Study type: Observational

Clinical Trial Summary

The investigators tried to determined whether the less D2B time led to costs savings benefited insurance payer and better outcomes to patients.

Description:

The relationship between the quality of care and costs has been discussed widely. Higher costs of care did not bring better outcomes, vice versa. However, as the rising spending of health care, the health care providers, insurance payers, governments, and consumers begin to pursue the higher quality of cares with lowest costs. In surgical experiences, improving the process of care succeeded to improve the quality of care and reduce the costs.

In patients with acute ST-Segment elevation myocardial infarction (STEMI), A Door-to-Balloon (D2B) time of less than 90 minutes has been established as the gold standard for primary percutaneous coronary intervention (PCI) and was associated with lower in-hospital mortality.9 Only less literatures discussed the costs and the quality of care in acute STEMI, and whether improving processes of care associated with lower costs was still controversial. The Premier Hospital Quality Incentive Demonstration (PHQID) in United State improved the processes of care but had not a significant effect on cost. Another single hospital experience in Indiana, USA, showed that the reducing D2B time in STEMI decreased the insurance payments as well as the total hospital costs. However, this study design was before-and-after intervention analysis, did not actually measure the impact of D2B time. Besides, the payment system in this study was prospective payment, not fee-for-service payment in Taiwan.

In this study, we tried to determined whether the less D2B time led to costs savings benefited insurance payer and better outcomes to patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 215
• Est. completion date: July 2010
• Est. primary completion date: July 2010
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• self visit

• acute STEMI by ECG definition

Exclusion Criteria:

• non-diagnosis on first ECG

• transferred

• diagnostic angiogram only

Study Design

Observational Model: Cohort, Time Perspective: Retrospective

Related Conditions & MeSH terms

• Acute STEMI
• Myocardial Infarction
• Primary Percutaneous Coronary Arterial Intervention

Locations

Country	Name	City	State
Taiwan	Far Eastern Memorial Hospital	Taipei

Sponsors (1)

Lead Sponsor	Collaborator
Far Eastern Memorial Hospital

Country where clinical trial is conducted

Taiwan,