Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: the EQUIP-ACS project protocol and design.
BACKGROUND
Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients. There is evidence that systematic educational programmes can lead to improvement in the management of these patients. Since application of the results of important clinical trials and expert clinical guidelines into clinical practice leads to improved patient care and outcomes, we propose to test a quality improvement programme in a general group of hospitals in Europe.


METHODS
This will be a multi-centre cluster-randomised study in 5 European countries: France, Spain, Poland, Italy and the UK. Thirty eight hospitals will be randomised to receive a quality improvement programme or no quality improvement programme. Centres will enter data for all eligible non-ST segment elevation acute coronary syndrome patients admitted to their hospital for a period of approximately 10 months onto the study database and the sample size is estimated at 2,000-4,000 patients. The primary outcome is a composite of eight measures to assess aggregate potential for improvement in the management and treatment of this patient population (risk stratification, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose and at discharge). After the quality improvement programme, each of the eight measures will be compared between the two groups, correcting for cluster effect.


CONCLUSIONS
If we can demonstrate important improvements in the quality of patient care as a result of a quality improvement programme, this could lead to a greater acceptance that such programmes should be incorporated into routine health training for health professionals and hospital managers.


BACKGROUND
Clinicaltrials.gov NCT00716430.
Flather
Marcus D
MD
Clinical Trials and Evaluation Unit, Royal Brompton Hospital, Sydney Street, SW7 6NP, UK. m.flather@rbht.nhs.uk
Booth
Jean
J
Babalis
Daphne
D
Bueno
Hector
H
Steg
Philippe G
PG
Opolski
Grzegorz
G
Ottani
Filippo
F
Machecourt
Jacques
J
Bardaji
Alfredo
A
Bojestig
Mats
M
Brady
Anthony R
AR
Lindahl
Bertil
B
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000191:economics / Q000401:mortality / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D003362:Cost-Benefit Analysis; D005060:Europe; D005240:Feasibility Studies; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016730:Program Development; D015397:Program Evaluation; D019984:Quality Indicators, Health Care / Q000191:economics; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors