Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme E uropean QU ality I mprovement P rogramme for A cute C oronary S yndrome: The EQUIP-ACS project protocol and design

Flather, Marcus; Booth, Jean; Babalis, Daphne; Bueno, Héctor; Steg, Philippe Gabriel; Opolski, Grzegorz; Ottani, Filippo; Machecourt, J; Bardajı́, Alfredo; Bojestig, Mats; Brady, Tony; Lindahl, Bertil

doi:10.1186/1745-6215-11-5

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…Apart from specific new therapies, there are also many more efficient ways to deliver existing treatments and the concept of improving the quality of care is growing through observational studies and randomized trials [26]. Finally, there are the major issues of cost and regulation in conducting trials in ACS.…”

Section: Discussionmentioning

confidence: 99%

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

2010

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Acute coronary syndromes (ACS) are common and carry a high risk of death and serious complications. Over the past three decades, the international cardiology community has collaborated in numerous large, well-designed randomized trials evaluating promising new treatments leading to important improvements in care for patients with ACS. Industry has funded most of the ACS trials of new pharmacologic treatments, but there are many independently funded trials evaluating treatment strategies such as percutaneous coronary intervention. Improvements in ACS care have led to challenges in demonstrating the efficacy of new treatments and many current trials are comparing one active treatment against another, although new paradigms including anti-inflammatory treatments and stem cell infusions are being tested against placebo. Developing new drugs for ACS is a very expensive process with many trials not showing any benefit, and much of this expense is related to the cost of large multicenter phase 3 trials. Reducing the administrative burden and associated costs of ACS trials is an important immediate goal if the strong tradition of large collaborative trials is to continue, as well as the need for health care providers to engage more actively in the clinical research process and support large multinational independently funded trials. We discuss methodologic issues of ACS trials with recent examples and provide some perspectives for the future.

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Section: Discussionmentioning

confidence: 99%

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

2010

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“…The Pearson χ 2 and Wilcoxon rank sum tests were used to compare categorical and continuous variables, which are summarized as the percentage and median (IQR), respectively. We used multilevel mixed-effects regression models to examine the association of NCPCP with the quality of service provision for male and female patients with ACS, with adjustment for clustering at the hospital level and allowing for hospital-level estimates as random effects . The statistical models were evaluated for goodness of fit using likelihood ratio tests.…”

Section: Methodsmentioning

confidence: 99%

Sex Disparities in Management and Outcomes Among Patients With Acute Coronary Syndrome

Zhou,

Zhang,

Dong

et al. 2023

JAMA Netw Open

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ImportanceSex disparities in the management and outcomes of acute coronary syndrome (ACS) have received increasing attention.ObjectiveTo evaluate the association of a quality improvement program with sex disparities among patients with ACS.Design, Setting, and ParticipantsThe National Chest Pain Centers Program (NCPCP) is an ongoing nationwide program for the improvement of quality of care in patients with ACS in China, with CPC accreditation as a core intervention. In this longitudinal analysis of annual (January 1, 2016, to December 31, 2020) cross-sectional data of 1 095 899 patients with ACS, the association of the NCPCP with sex-related disparities in the care of these patients was evaluated using generalized linear mixed models and interaction analysis. The robustness of the results was assessed by sensitivity analyses with inverse probability of treatment weighting. Data were analyzed from September 1, 2021, to June 30, 2022.ExposureHospital participation in the NCPCP.Main Outcomes and MeasuresDifferences in treatment and outcomes between men and women with ACS. Prehospital indicators included time from onset to first medical contact (onset-FMC), time from onset to calling an emergency medical service (onset-EMS), and length of hospital stay without receiving a percutaneous coronary intervention (non-PCI). In-hospital quality indicators included non-PCI, use of statin at arrival, discharge with statin, discharge with dual antiplatelet therapy, direct PCI for ST-segment elevation myocardial infarction (STEMI), PCI for higher-risk non–ST-segment elevation ACS, time from door to catheterization activation, and time from door to balloon. Patient outcome indicators included in-hospital mortality and in-hospital new-onset heart failure.ResultsData for 1 095 899 patients with ACS (346 638 women [31.6%] and 749 261 men [68.4%]; mean [SD] age, 63.9 [12.4] years) from 989 hospitals were collected. Women had longer times for onset-FMC and onset-EMS; lower rates of PCI, statin use at arrival, and discharge with medication; longer in-hospital delays; and higher rates of in-hospital heart failure and mortality. The NCPCP was associated with less onset-FMC time, more direct PCI rate for STEMI, lower rate of in-hospital heart failure, more drug use, and fewer in-hospital delays for both men and women with ACS. Sex-related differences in the onset-FMC time (β = −0.03 [95% CI, −0.04 to −0.01), rate of direct PCI for STEMI (odds ratio, 1.11 [95% CI, 1.06-1.17]), time from hospital door to balloon (β = −1.38 [95% CI, −2.74 to −0.001]), and rate of in-hospital heart failure (odds ratio, 0.90 [95% CI, 0.86-0.94]) were significantly less after accreditation.Conclusions and RelevanceIn this longitudinal cross-sectional study of patients with ACS from hospitals participating in the NCPCP in China, sex-related disparities in management and outcomes were smaller in some aspects by regionalization between prehospital emergency and in-hospital treatment systems and standardized treatment procedures. The NCPCP should emphasize sex disparities to cardiologists; highlight compliance with clinical guidelines, particularly for female patients; and include the reduction of sex disparities as a performance appraisal indicator.

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“…We used a multilevel mixed‐effects linear regression model to examine factors associated with medical staff engagement and evaluation of the QI program, adjusting for clustering at hospital level and allowing for hospital‐level estimates as random effects. 28 , 29 The goodness of fit for statistical models was evaluated using likelihood ratio tests. Engagement was measured as a continuous variable, whereas behavior changes, satisfaction, and sustainability of the QI program were measured as dichotomous variables.…”

Section: Methodsmentioning

confidence: 99%

Factors Associated With Medical Staff’s Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed‐Methods Study in China

Zhou

Jin

et al. 2022

JAHA

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Background Medical staff represent critical stakeholders in the process of implementing a quality improvement (QI) program. Few studies, however, have examined factors that influence medical staff engagement and perception regarding QI programs. Methods and Results We conducted a nationally representative survey of a QI program in 6 cities in China. Quantitative data were analyzed using multilevel mixed‐effects linear regression models, and qualitative data were analyzed using the framework method. The engagement of medical staff was significantly related to knowledge scores regarding the specific content of chest pain center accreditation (β=0.42; 95% CI, 0.27–0.57). Higher scores for inner motivation (odds ratio [OR], 1.79; 95% CI, 1.18–2.72) and resource support (OR, 1.52; 95% CI, 1.02–2.24) and lower scores for implementation barriers (OR, 0.81; 95% CI, 0.67–0.98) were associated with improved treatment behaviors among medical staff. Resource support (OR, 4.52; 95% CI, 2.99–6.84) and lower complexity (OR, 0.81; 95% CI, 0.65–1.00) had positive effects on medical staff satisfaction, and respondents with improved treatment behaviors were more satisfied with the QI program. Similar findings were found for factors that influenced medical staff’s assessment of QI program sustainability. The qualitative analysis further confirmed and supplemented the findings of quantitative analysis. Conclusions Clarifying and addressing factors associated with medical staff’s engagement and perception of QI programs will allow further improvements in quality of care for patients with acute coronary syndrome. These findings may also be applicable to other QI programs in China and other low‐ and middle‐income countries. Registration URL: https://www.chictr.org.cn/ ; Unique identifier: Chi‐CTR2100043319.

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Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme E uropean QU ality I mprovement P rogramme for A cute C oronary S yndrome: The EQUIP-ACS project protocol and design

Cited by 12 publications

References 29 publications

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

What Goes Into a Major Acute Coronary Syndrome Trial and What Will Future Trials Look Like?

Sex Disparities in Management and Outcomes Among Patients With Acute Coronary Syndrome

Factors Associated With Medical Staff’s Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed‐Methods Study in China

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