OPTIMIZING ROUTING OF PATIENTS WITH ACUTE CORONARY SYNDROME IN THE KURSK REGION USING "CARDIONET" INFORMATION SYSTEM
Authors:   Bashkir State Medical University, Oleynik B.A. , Starodubov V.I. ,   Russian Research Institute of Health of the Ministry of Health of the Russian Federation, Moscow, Evdakov V.A. ,   Russian Research Institute of Health of the Ministry of Health of the Russian Federation, Moscow
Published: May 2022

Significance. Reserving resources of the health care system to combat the spread of the new coronavirus infection makes it relevant to identify unused reserves for reducing mortality from diseases of the circulatory system through a more efficient use of the resources available to the regions to control cardiovascular diseases, as well as using resources of the neighboring regions through effective schemes of interregional routing of patients. Purpose. To assess performance and predictive accuracy of the developed information system "Cardionet" in ambulance service and, using this system, to analyze the existing routing schemes for patients with acute coronary syndrome (ACS) in the Kursk region to select the optimal routing schemes in terms of the time spent on transporting patients with ACS to cardiovascular centers, including cases of interregional cooperation. Material and methods. Performance and predictive accuracy of the "Cardionet" information system were analyzed on the basis of the ambulance service of the Kursk region. The digital twin of the Kursk region was used to study the time indicators of transportation of patients with acute coronary syndrome by ambulance teams to medical organizations on the basis of the current procedure versus routing with automatically determined optimal route, including during interregional cooperation with cardiovascular centers of the neighboring regions. Results. The difference between the estimated and actual time of transportation when using the “Cardionet” information system equaled to 1.17 ± 5.52 minutes on average (p=0.1534), which is statistically insignificant and indicates a high predictive accuracy of the software product for calculating the patient transportation time. Due to introduction of the interregional cooperation, the regional average transportation time for patients with acute coronary syndrome with ST segment elevation was reduced by 10.43 ± 5.39 minutes, with the estimated decrease in mortality from myocardial infarction equaling to 2.62%. In four districts of the region, the time saved ranged from 41.5 ± 19.99 to 95.4 ± 21.52 minutes, and the predicted decrease in mortality from myocardial infarction - from 10.43% to 23.91%. In six out of 28 districts of the Kursk region, the routing of patients with acute coronary syndrome without ST-segment elevation is suboptimal in terms of the transportation time. Improvement of the routing schemes using the “Cardionet” information system will save 11.63 ± 4.37 to 40.05 ± 13.65 minutes on average. Conclusion. The use of the “Cardionet” information system for routing patients with acute coronary syndrome helps to decrease time required for patient transportation to medical organizations, which is a significant reserve for reducing mortality from diseases of the circulatory system.