Q&A: Expanded Access to Care, Beyond Boston
In cardiology, it’s known as door-to-balloon time – the recommended 90-minute window for treating ST-Elevation Myocardial Infarction (STEMI), a severe heart attack caused by a complete blockage in a coronary artery. Those 90 minutes can be critical for a patient’s survival.
STEMI carries a high risk of disability or mortality without rapid treatment. The recommended therapy for STEMI patients is percutaneous coronary intervention (PCI), which uses stents, angioplasty or similar mechanical methods to open the arteries. However, access to this treatment is not widespread; only 39 percent of U.S. hospitals have the equipment, expertise and facilities to deliver PCI, according to the American Hospital Association.
Until recently, Kent Hospital in Warwick, R.I., was not among them. Patients who came to Kent’s emergency department and were diagnosed with a STEMI had to be transferred, a process that cuts into that 90-minute window. But thanks to a long-time partnership with BWH, Kent treated its first STEMI patient in its Cardiac Catheterization Lab this spring. The patient, a man in his 20s, made a full recovery. It is the latest of several milestones the hospital has achieved as a result of its relationship with the Brigham.
Kent is one of three Rhode Island hospitals whose cardiology practices make up Brigham and Women’s Cardiovascular Associates at Care New England, a partnership that began in 2009 with Care New England. BWH-affiliated cardiologists see patients not only at Kent but also at Women & Infants Hospital in Providence and Memorial Hospital in Pawtucket.
Part of BWH’s primary and secondary care network, the practice brings advanced cardiac care and access to clinical trial enrollment closer to home for Rhode Islanders. Working in close partnership with cardiologists on BWH’s main campus, care providers in Rhode Island have also been able to expand the services they offer, increasing both in volume and sophistication.
Care New England Health System announced in April that it signed a letter of intent to affiliate with Partners HealthCare; both organizations are working to develop an agreement, which must then receive state and federal regulatory approval.
Dale Adler, MD, executive vice chair of the Department of Medicine, recently spoke with BWH Clinical & Research News about the Brigham’s network of cardiology services in Rhode Island and the benefits of strengthening our care networks.
Why is this relationship beneficial for patients?
DA: People who live in the Warwick area of Rhode Island are receiving a level of care that wasn’t available to them before. Electrophysiology is a good example. Kent had many patients who sought care related to problems caused by their heart’s electrical system. Their care was being managed without the benefit of electrophysiological procedures. The reasons for that gap in appropriate care were the absence of electrophysiology programs locally and the reluctance on the part of many people to travel to a bigger city to receive that care.
There was a wonderful benefit to having the Brigham and Kent team up: Patients could be evaluated by Brigham physicians who are experts in their field, and they could have many of the procedures they needed without leaving the state. It’s not just a matter of convenience; it also affects affordability. When you can provide care in a community hospital, it’s done at a lower cost than at a large academic medical center.
What about research?
DA: Many of the cardiology trials we do at the Brigham, such as the ones conducted by the TIMI Study Group, enlisted our Rhode Island physicians as investigators, who have successfully made trials available to Rhode Island patients. The Rhode Island patients benefit from the new options they have available, and our research enterprise benefits.
Why is it so notable that Kent now handles STEMI cases?
DA: The people of Warwick and the surrounding area should be able to access care for these serious medical events – when time is of the essence – very close to them, as opposed to arriving at Kent and then getting helicoptered to the Brigham or transferred to a hospital in Providence. We knew that we could really help this population if we treated STEMI right here.
Any time we can provide care at a local level, we should do it.
The benefits for patients seem clear, but how does a partnership like this help the Brigham? Aren’t we trying to increase our volume?
DA: That’s the critical question in all of this. To secure our financial strength now and in the future and to ensure we are providing the right care in the right place, we are committed to enhancing our ability to provide appropriate tertiary and quaternary care cases at BWH. These are the cases we are uniquely positioned to handle at the Brigham in a way that most benefits patients and families. Complex patients – such as those with advanced heart failure who might need an assist device or a possible transplant – require the kinds of resources that are often not available at community hospitals; however, we are well-equipped to address them here.
Through this partnership, Kent providers refer the most complex cardiovascular patients to the Brigham seamlessly. Before a patient in need of complex care is transferred to the Brigham, the team here has already been using telemedicine to communicate with the care team at Kent. That means that we understand the patient’s history from the moment they arrived at Kent. Together, we figure out what should be done at Kent and when the transfer to BWH should occur. When that patient is transferred here, are able to be much more efficient in determining what care is needed. We know exactly what’s going on.
From the family’s standpoint, it’s a much simpler process because they know why they’re coming and when. Then, when the patient obtains whatever treatment is needed required here and begins to recover, we can quickly get them back to the community hospital. So the family driving an hour and a half to visit someone here doesn’t have to do that anymore.