The dissociation between door-to-balloon time improvement and improvements in other acute myocardial infarction care processes and patient outcomes

Abstract

Background: Recent initiatives have focused on reducing door-to-balloon (DTB) times among patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. However, DTB time is only one of several important AMI care processes. It is unclear whether quality efforts targeted to a single process will facilitate concomitant improvement in other quality measures and outcomes. Methods: This study examined 101 hospitals (43 678 patients with AMI) in the Get With the Guidelines program. For each hospital, DTB time improvement from 2005 to 2007 was correlated with changes in composite Centers for Medicare and Medicaid Services/Joint Commission on Accreditation of Healthcare Organizations (CMS/JCAHO) core measure performance and inhospital mortality. Results: Between 2005 and 2007, hospital geometric mean DTB time decreased from 101 to 87 minutes (P