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1. How does Mission: Lifeline respond to the varied interests of competing hospitals and cardiology groups, multiple EMS providers, and access and control of critical care transport or helicopters regarding the system plan?

Realizing that all of these entities come to the table with their own agendas, priorities and concerns, Mission: Lifeline seeks to build a consensus around what is best for the patient according to data, guidelines, resources and local leadership.

2. What are some common perceptions other parties within a system of care may have regarding receiving centers that must be overcome in order to build more cohesive partnerships?

Emergency medical service (EMS) providers and referral centers that treat patients who are then transferred to a receiving center often face a “black hole” experience. Once the patient is out of their care, they are left with questions about outcomes and whether their contributions to treatment helped achieve success. To improve quality of care and recognize the contribution that EMS and referral centers play in the treatment of STEMI and cardiac resuscitation patients, the receiving centers, or PCI centers, must close this communication gap.

Furthermore, referral centers may feel that diverting or transferring STEMI patients to PCI-capable hospitals will result in substantial lost revenue. While STEMI victims make up the minority of heart attack patients, this perceived economic threat to non-PCI hospitals must be addressed.

3. What kind of measurement of performance and accountability at a systems level is needed?

Ongoing evaluation of any system of care is critical. For this reason, the American Heart Association dedicated an entire manuscript (published in Circulation) to the evaluation and outcomes of STEMI systems of care. The expert group that we have convened to oversee Mission: Lifeline has reviewed the recommendations in the manuscript and prioritized the evaluation components necessary to measure the success and effectiveness of the initiative. Measurable patient outcomes and an evaluation mechanism to ensure quality-of-care measures reflect changes in evidence-based research, including consensus-based treatment guidelines, are two of our guiding principles.