Evaluation of Cardiac System of Care

The Cardiac System of Care project aims at improving the efficiency and the effectiveness of the cardiac system of care in the seven states funded by The Leona M. and Harry B. Helmsley Charitable Trust: Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, and Wyoming. All seven states are challenged with providing cardiac care to a small population spread across a large area. The rural healthcare delivery grants, however, allow these states to invest in initiatives to strengthen the efficiency of the cardiac system of care. One example is the investment in LUCAS® 2 mechanical cardiopulmonary resuscitation (CPR) devices, which may prove especially useful in rural areas with long hospital transportation times and stressed emergency medical resources.

The cardiac system of care consists of many subsystems, including: bystanders, 911 emergency dispatch centers, emergency medical services (EMS), critical access hospitals and tertiary care facilities. The likelihood of surviving a cardiac arrest depends on the streamlined coordination of these subsystems. Every minute of delay in care reduces the likelihood of survival. The American Heart Association's Heart Disease and Stroke Statistics – 2013 Update states that the national survival rate for bystander witnessed out-of-hospital cardiac arrest with shockable rhythm is 28.4%. Survival rates, however, vary considerably from community to community. According to Every Second Counts. Every Action Matters. A Community Response Planning Guide for Sudden Cardiac Arrest by the Medtronic Foundation Heart Rescue Project, those survival rates range from 0% to 52%. Community initiatives improving the timeliness and the quality of the care delivered by the cardiac system of care increase survival rates.

Streamlined coordination between subsystems depends on strong leadership, highly trained staff and bystanders, interoperable information technology systems, commitment and continuous quality improvement efforts, and a culture of excellence. All of these attributes must be continually monitored and evaluated to ensure the maximal system efficiency and effectiveness.

Project Goals

  • With respect to the LUCAS® 2 mechanical CPR devices:
    • Monitor statewide distribution and share lessons learned to streamline distribution.
    • Evaluate trainings to ensure prehospital and hospital health professionals are competent and capable.
    • Capture the impact using qualitative methods.
    • Collect data on non-patient outcomes.
    • Provide usable recommendation reports as needed.
  • With respect to the cardiac care system of care:
    • Define system processes necessary for efficient and effective cardiac care.
    • Assess the system feedback mechanisms to ensure they are providing credible and timely data needed for continuous quality improvement.
    • Evaluate critical system attributes necessary for system efficiency and effectiveness, including: leadership, culture, training, and information technology.
    • Advance system evaluation theory and methods.

Most Recent Publications

  • Evaluating System Cascading Failures
    In the article, Renger and coauthors share methods used to evaluate system cascading failures.
    Author(s): Renger, R., Foltysova, J., Ienuso, S., Renger, J., Booze, W.
    Publication: Evaluation Journal of Austalasia, 17(2), 29-36
    Date: June 2017
    Type: Journal Article
  • Illustrating the Evaluation of System Feedback Mechanisms using System Evaluation Theory (SET)
    This article illustrates how system evaluation theory guided the evaluation of system feedback mechanisms within the cardiac care response systems of seven rural states.
    Author(s): Renger, R.
    Publication: Evaluation Journal of Australasia, 16(4), 14-20
    Date: December 2016
    Type: Journal Article
  • Challenges and Solutions Facing EMS in Supporting the IOM Recommendation for a National Cardiac Arrest Registry: A System Perspective
    This white paper uses systems theory to focus on the feasibility of the Institute of Medicine’s recommendation to support a national cardiac arrest registry.
    Author(s): Renger, R., Qin, X, Rice, D., Foltysova, J., Souvannasacd, E., Renger, J. Markwart, B., Hart, G., Bjerke, M.B.
    Date: September 2016
    Type: Report
  • Process Flow Mapping for Systems Improvement: Lessons Learned
    The article details how to conduct process flow mapping for systems improvement. The method and its importance are explained in the context of evaluating a cardiac care system.
    Author(s): Renger, R., McPherson, M., Kontz-Bartels, T., Becker, K.
    Publication: The Canadian Journal of Program Evaluation, 31(1)
    Date: July 2016
    Type: Journal Article
  • National Data Collection Efforts Pose Challenges for Many EMS Agencies
    Rural EMS agencies face challenges in participating in national data collection efforts. The article presents the consequences of these challenges and propose some suggestions for EMS leadership when confronted with requests to participate in national data collection efforts. Note: Login is required.
    Author(s): Renger, R., Qin, X., Rice, D., Foltysova, J., & Renger, J.
    Publication: EMS Insider
    Date: June 2016
    Type: Journal Article

Most Recent Presentations