The impact of emergency quality improvement program on the prognosis of patients with acute ST-segment elevation myocardial infarction in Taiwan

Ischemic heart disease remains a leading cause of mortality worldwide. Since 2012, Taiwan has implemented the Emergency Quality Improvement Program (EQIP) to promote timely care for patients with ST-segment elevation myocardial infarction (STEMI). Using Taiwan's National Health Insurance Research Database (2013-2018), we conducted a nationwide retrospective cohort study of emergency department visits with a principal diagnosis of STEMI to examine factors associated with EQIP adherence and its association with intensive care unit (ICU) length of stay and short-term mortality. EQIP adherence was defined by achieving time-based process indicators recorded in claims data. Propensity score matching (1:1) and generalized estimating equation models were applied. Male sex, younger age, lower comorbidity burden, absence of prior coronary stent placement, higher triage acuity, and treatment at medical centers were associated with greater adherence. After matching, EQIP-adherent patients had a shorter ICU stay and lower 30-day mortality. In adjusted analyses, adherence was associated with a 24% lower odds of 30-day mortality (OR = 0.76, 95% CI: 0.66-0.87). These findings suggest that adherence to EQIP care indicators is associated with improved short-term outcomes among patients with STEMI and support the potential value of system-level quality improvement programs.