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Developing an appropriate STEMI system of care in India: The STEMI India model

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Dr Thomas Alexander, Coimbatore    01 December 2017

The STEMI India model for STEMI management combines the two reperfusion strategies of primary PCI and pharmacoinvasive treatment to build a hub and spoke model. It has shown a significant reduction in mortality and MACE in the implementation phase vs the pre implementation phase in the Tamil Nadu TN STEMI Program. Cost Effectiveness Analysis as per WHO methods indicates that STEMI India Model is efficacious effective and cost effective vs the no intervention case. TN STEMI program was conducted in 4 clusters a set of spokes connected to a hub via data linkages and an ambulance network is dubbed a cluster in Tamil Nadu. The integrated regional quality improvement program that was developed linked the3 5 spoke health care centres to the 4 large PCI hub hospitals and leveraged recent developments in public health insurance schemes emergency medical services and health information technology. The STEMI Kit a Multifunctional 12 lead ECG integrated multi parameter monitoring unit with data entry capability which was used in the TN STEMI program significantly helped to improve diagnostic accuracy of STEMI and quality of data capture. Many of these data entry in real time helped in quality improvement. The role of a state wide ambulance service was critical in the success of the TN STEMI Program. ACS patients from the lower socio economic strata have a higher percentage of STEMI use less evidence based treatment and have a higher mortality. STEMI care can be delivered to this class of STEMI patients through a government insurance scheme. STEMI India has developed the model run the TN STEMI program designed the STEMI Kit with its partners and has developed the software to run the program. It has acquired unique competencies to run similar programs in other states and countries and is in the process of doing so.

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