ArticlePloS one2014
System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Engaging Healthcare Staff and Stakeholders in Healthcare Simulation Modeling to Better Translate Research Into Health Impact: A Systematic Review.Frontiers in health services · 2021Pooled it
- A System Dynamics Simulation Applied to Healthcare: A Systematic Review.International journal of environmental research and public health · 2020Pooled it
- Mathematical modelling for health systems research: a systematic review of system dynamics and agent-based models.BMC health services research · 2019Pooled it
- Identifying the active ingredients in payment for performance programmes using system dynamics modelling.SSM - health systems · 2025Article
- A Study on CKD Progression and Health Disparities Using System Dynamics Modeling.Healthcare (Basel, Switzerland) · 2022Article
- The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis.Global heart · 2021Article
- Review
- Article
- Observational
- Understanding Emergency Care Delivery Through Computer Simulation Modeling.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2018Article
- Acute care for the three leading causes of mortality in lower-middle-income countries: A systematic review.International journal of critical illness and injury scienceReview
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMortality 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
findingsThe 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.
conclusionsThis 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.
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