IntroductionThe patient journey for residents of New South Wales (NSW) Australia with ST-elevation myocardial infarction (STEMI) often involves transfer between hospitals and these can include stays in hospitals in other jurisdictions. ObjectiveTo estimate the change in enumeration of STEMI hospitalisations and time to subsequent cardiac procedures for NSW residents using cross-jurisdictional linkage of administrative health data. MethodsRecords for NSW residents aged 20 years and over admitted to hospitals in NSW and four adjacent jurisdictions (Australian Capital Territory, Queensland, South Australia, and Victoria) between 1 July 2013 and 30 June 2018 with a principal diagnosis of STEMI were linked with records of the Australian Government Medicare Benefits Schedule (MBS). The number of STEMI hospitalisations, and rates of angiography, percutaneous coronary intervention and coronary artery bypass graft were compared for residents of different local health districts within NSW with and without inclusion of cross-jurisdictional data. ResultsInclusion of cross-jurisdictional hospital and MBS data increased the enumeration of STEMI hospitalisations for NSW residents by 8% (from 15,420 to 16,659) and procedure rates from 85.6% to 88.2%. For NSW residents who lived adjacent to a jurisdictional border, hospitalisation counts increased by up to 210% and procedure rates by up to 70 percentage points. ConclusionsCross-jurisdictional linked hospital data is essential to understand patient journeys of NSW residents who live in border areas and to evaluate adherence to treatment guidelines for STEMI. MBS data are useful where hospital data are not available and for procedures that may be conducted in out-patient settings.

Background For patients experiencing acute myocardial infarction (AMI), particularly ST-elevation myocardial infarction (STEMI), timely revascularisation is important to optimise prognosis. The AMI patient journey often involves presentation to the closest appropriate facility and transfers between hospitals, including across jurisdictions. The Better Cardiac Care (BCC) dataset consists of cross-jurisdictional linked ambulance, emergency, hospital, outpatient, deaths, Medicare and Pharmaceutical Benefits Scheme records for residents of New South Wales (NSW), Australia. This dataset will be updated annually. Methods The BCC dataset comprises 332 million records, from 18 datasets, across 6 jurisdictions. For NSW residents hospitalised for STEMI between 2013 to 2018, we compared the number of STEMI hospitalisations, the proportion of patients receiving revascularisation procedures, and the time to procedures using only NSW records versus records from all jurisdictions and Medicare Benefits Scheme. Results Compared with NSW hospital data, including data from other jurisdictions increased the ascertainment of STEMI hospitalisations by 8.0% and procedures by 11.2% for NSW residents. This increase was greatest for residents living near state borders, increasing the number of STEMI hospitalisations by up to 210% and the percentage receiving procedures by up to 70%. Conclusions Cross-jurisdictional data is essential to understand patient journeys of residents who live in border areas and to evaluate patient care for STEMI and AMI more broadly. Key messages The BCC dataset is a vital asset that enables a more comprehensive view of care for AMI than has been possible to date.