**5. Conclusions**

In conclusion, our study confirms the effectiveness of the new hub-and-spoke organizational model of the Veneto Region's network for AMI in facilitating primary PCI on STEMI and reducing in-hospital mortality. The present study also emphasizes that the implementation of organizational models and/or standardized protocols should be monitored with the aid of up-to-date administrative datasets to see whether a given strategy reduces health care disparities.

Based on such indicators, the present study revealed numerous opportunities for improvements and adaptations to the intervention, and for regularly collecting process measures. At the same time, it will be helpful not only to use administrative databases, but also to introduce qualitative assessment methods (e.g., surveys, interviews) to identify problems and target areas that might require more in-depth investigations based on more specific data.

Even though the new network improved the process of care for STEMI and reduced disparities in this process between all population subgroups, this did not generate the expected survival benefit in all patient subgroups.

The present findings could prompt policy-makers to seriously consider the feasibility of designing and implementing programs for health care providers, organizations, and community groups, and

policies that focus not only on patients. Finally, sharing feedback with providers, and incentivizing them to reduce disparities could have an important role.

**Author Contributions:** V.B., M.S. (Mario Saia) obtained funding, coordinated all study phases, and approved the final manuscript as submitted. M.S. (Milena Sperotto) carried out the statistical analyses, and approved the final manuscript as submitted. P.F. designed the data collection instruments, and coordinated and supervised data collection. C.B., M.F., M.S. (Marta Soattin) drafted the manuscript, and approved the final manuscript as submitted. A.B. conceptualized the study, coordinated all study phases, was involved in data collection, and approved the final manuscript as submitted. D.M., M.L.S., G.V., T.B., S.C. critically reviewed and revised the manuscript, and the interpretation of the data.

**Funding:** The Department of Cardiological, Thoracic and Vascular Sciences funded this research with a competitive call for grants awarded to stimulate collaboration between colleagues within the department.

**Conflicts of Interest:** The authors have no conflicts of interest to disclose.
