Skip to main content

System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.

Publication ,  Journal Article
de Andrade, L; Lynch, C; Carvalho, E; Rodrigues, CG; Vissoci, JRN; Passos, GF; Pietrobon, R; Nihei, OK; de Barros Carvalho, MD
Published in: PLoS One
2014

BACKGROUND: Mortality rates amongst ST segment elevation myocardial infarction (STEMI) patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines. METHODS AND FINDINGS: The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA) and System Dynamics Modeling (SD). Main cause of delays were categorized into three themes: a) professional, b) equipment and c) transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient's care in relation to the 'Door-in-Door-out' time at the primary hospital. These stages and their average delays in minutes were: a) First Medical Contact (From Door-In to the first contact with the nurse and/or physician): 7 minutes; b) Electrocardiogram acquisition and review by a physician: 28 minutes; c) ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d) Patient's Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system's behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay. CONCLUSIONS: This evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients' care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the process of care.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2014

Volume

9

Issue

7

Start / End Page

e103577

Location

United States

Related Subject Headings

  • Time and Motion Studies
  • Myocardial Infarction
  • Models, Organizational
  • Humans
  • General Science & Technology
  • Electrocardiography
  • Delivery of Health Care
  • Brazil
 

Citation

APA
Chicago
ICMJE
MLA
NLM
de Andrade, L., Lynch, C., Carvalho, E., Rodrigues, C. G., Vissoci, J. R. N., Passos, G. F., … de Barros Carvalho, M. D. (2014). System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system. PLoS One, 9(7), e103577. https://doi.org/10.1371/journal.pone.0103577
Andrade, Luciano de, Catherine Lynch, Elias Carvalho, Clarissa Garcia Rodrigues, João Ricardo Nickenig Vissoci, Guttenberg Ferreira Passos, Ricardo Pietrobon, Oscar Kenji Nihei, and Maria Dalva de Barros Carvalho. “System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.PLoS One 9, no. 7 (2014): e103577. https://doi.org/10.1371/journal.pone.0103577.
de Andrade L, Lynch C, Carvalho E, Rodrigues CG, Vissoci JRN, Passos GF, et al. System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system. PLoS One. 2014;9(7):e103577.
de Andrade, Luciano, et al. “System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.PLoS One, vol. 9, no. 7, 2014, p. e103577. Pubmed, doi:10.1371/journal.pone.0103577.
de Andrade L, Lynch C, Carvalho E, Rodrigues CG, Vissoci JRN, Passos GF, Pietrobon R, Nihei OK, de Barros Carvalho MD. System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system. PLoS One. 2014;9(7):e103577.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2014

Volume

9

Issue

7

Start / End Page

e103577

Location

United States

Related Subject Headings

  • Time and Motion Studies
  • Myocardial Infarction
  • Models, Organizational
  • Humans
  • General Science & Technology
  • Electrocardiography
  • Delivery of Health Care
  • Brazil