This policy brief summarizes the evidence for regional systems of care for patients presenting with ST-segment elevation myocardial infarction (STEMI). These systems of care have both a quality improvement and a systems development focus and provide a valuable opportunity for State Flex Programs to engage CAHs and EMS in rationalizing and improving STEMI care for rural residents, particularly with respect to MBQIP Phase 2 Measures.

Key Findings:

• CAHs and rural EMS agencies play an important role in STEMI systems of care.
• EMS providers use pre-hospital ECGs and transport protocols to ensure timely reperfusion.
• CAHs provide fibrinolytic therapy and post-reperfusion followup care including cardiac rehabilitation.
• State Flex Programs can facilitate involvement of CAHs and EMS agencies in STEMI systems of care.