Association of Rapid Care Process Implementation on Reperfusion Times Across Multiple ST-Segment–Elevation Myocardial Infarction Networks

BACKGROUND: The Mission: Lifeline STEMI Systems Accelerator program, implemented in 16 US metropolitan regions, resulted in more patients receiving timely reperfusion. We assessed whether implementing key care processes was associated with system performance improvement. METHODS AND RESULTS: Hospitals (n=167 with 23 498 ST-segment-elevation myocardial infarction patients) were surveyed before (March 2012) and after (July 2014) program intervention. Data were merged with patient-level clinical data over the same period. For reperfusion, hospitals were grouped by whether a specific process of care was implemented, preexisting, or never implemented. Uptake of 4 key care processes increased after intervention: prehospital catheterization laboratory activation (62%-91%; P<0.001), single call transfer protocol from an outside facility (45%-70%; P<0.001), and emergency department bypass for emergency medical services direct presenters (48%-59%; P=0.002) and transfers (56%-79%; P=0.001). There were significant differences in median first medical contact-to-device times among groups implementing prehospital activation (88 minutes implementers versus 89 minutes preexisting versus 98 minutes nonimplementers; P<0.001 for comparisons). Similarly, patients treated at hospitals implementing single call transfer protocols had shorter median first medical contact-to-device times (112 versus 128 versus 152 minutes; P<0.001). Emergency department bypass was also associated with shorter median first medical contact-to-device times for emergency medical services direct presenters (84 versus 88 versus 94 minutes; P<0.001) and transfers (123 versus 127 versus 167 minutes; P<0.001). CONCLUSIONS: The Accelerator program increased uptake of key care processes, which were associated with improved system performance. These findings support efforts to implement regional ST-segment-elevation myocardial infarction networks focused on prehospital catheterization laboratory activation, single call transfer protocols, and emergency department bypass

Payment systems in the United States and architectures enabled by digital currencies

Thesis: S.M. in Engineering and Management, Massachusetts Institute of Technology, School of Engineering, System Design and Management Program, 2017.Cataloged from PDF version of thesis.Includes bibliographical references (pages 69-71).A payment is a transfer of value from one party to another and cash is the simplest form of payment. However, the cost of cash transactions increases as the volume of transactions or distance between the parties involved increases. Various electronic payment systems have evolved over time to enable different types of transactions in the economy. Payment systems are now the backbone of the economy and trillions of dollars are exchanged on the payment system rails every year. Central banks, payment processors, payment gateways, credit card issuers and banks are just a few of the counterparties which enable payments across a multitude of counterparties for their specific needs. An extremely complex technological architecture enables these transactions. Central banks are now considering the issuance of digital currencies to increase efficiency in payments. Blockchain could potentially simplify payments systems and reduce market inefficiencies. It can provide a way for multiple counterparties to connect on the same platform and reduce the time for clearing and settlement. In this thesis, I study the technology and stakeholder needs to propose novel architectures that could be adopted for payments processing.by Akshay Bagai.S.M. in Engineering and Managemen