title: Cluster-randomized trial to evaluate the effects of a quality improvement program on management of non-ST-elevation acute coronary syndromes: The European Quality Improvement Programme for Acute Coronary Syndromes (EQUIP-ACS).
abstract: BACKGROUND
  Registries have shown that quality of care for acute coronary syndromes (ACS) often falls below the standards recommended in professional guidelines. Quality improvement (QI) is a strategy to improve standards of clinical care for patients, but the efficacy of QI for ACS has not been tested in randomized trials.
  
  
  METHODS
  We undertook a prospective, cluster-randomized, multicenter, multinational study to evaluate the efficacy of a QI program for ACS. Participating centers collected data on consecutive admissions for non-ST-elevation ACS for 4 months before the QI intervention and 3 months after. Thirty-eight hospitals in France, Italy, Poland, Spain, and the United Kingdom were randomized to receive the QI program or not, 19 in each group. We measured 8 in-hospital quality indicators (risk stratification, coronary angiography, anticoagulation, β-blockers, statins, angiotensin-converting enzyme inhibitors, and clopidogrel loading and maintenance) before and after the intervention and compared composite changes between the QI and non-QI groups.
  
  
  RESULTS
  A total of 2604 patients were enrolled. The absolute overall change in use of quality indicators in the QI group was 8.5% compared with 0.8% in the non-QI group (odds ratio for achieving a quality indicator in QI versus non-QI 1.66, 95% CI 1.43-1.94; P < .001). The main changes were observed in the use of risk stratification and clopidogrel loading dose.
  
  
  CONCLUSIONS
  The QI strategy resulted in a significant improvement in the quality indicators measured. This type of QI intervention can lead to useful changes in health care practice for ACS in a wide range of settings.
authors: Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom. m.flather@rbht.nhs.uk
authors: Marcus D
authors: MD
authors: Flather
authors: Daphne
authors: D
authors: Babalis
authors: Jean
authors: J
authors: Booth
authors: Alfredo
authors: A
authors: Bardaji
authors: Jacques
authors: J
authors: Machecourt
authors: Grzegorz
authors: G
authors: Opolski
authors: Filippo
authors: F
authors: Ottani
authors: Héctor
authors: H
authors: Bueno
authors: Winston
authors: W
authors: Banya
authors: Anthony R
authors: AR
authors: Brady
authors: Mats
authors: M
authors: Bojestig
authors: Bertil
authors: B
authors: Lindahl
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D058996:Quality Improvement