title: Hospital quality improvement initiative for patients with acute coronary syndromes in China: a cluster randomized, controlled trial.
abstract: Background- Substantial evidence-practice gaps exist in the management of acute coronary syndromes (ACS) in China. Clinical pathways are tools for improving ACS quality of care but have not been rigorously evaluated. Methods and Results- Between October 2007 and August 2010, a quality improvement program was conducted in 75 hospitals throughout China with mixed methods evaluation in a cluster randomized, controlled trial. Eligible hospitals were level 2 or level 3 centers routinely admitting >100 patients with ACS per year. Hospitals were assigned immediate implementation of the American Heart Association/American College of Cardiology guideline based clinical pathways or commencement of the intervention 12 months later. Outcomes were several key performance indicators reflecting the management of ACS. The key performance indicators were measured 12 months after commencement in intervention hospitals and compared with baseline data in control hospitals, using data collected from 50 consecutive patients in each hospital. Pathway implementation was associated with an increased proportion of patients discharged on appropriate medical therapy, with nonsignificant improvements or absence of effects on other key performance indicators. Conclusions- Among hospitals in China, the use of a clinical pathway for the treatment of ACS compared with usual care improved secondary prevention treatments, but effectiveness was otherwise limited. An accompanying process evaluation identified several health system barriers to more successful implementation. Clinical Trial Registration- URL: http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
authors.affiliation: The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
authors.forename: Fiona
authors.initials: F
authors.lastname: Turnbull
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
authors.forename: Ye
authors.initials: Y
authors.lastname: Rong
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.forename: Laurent
authors.initials: L
authors.lastname: Billot
authors.forename: Zhixin
authors.initials: Z
authors.lastname: Hao
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.forename: Rick
authors.initials: R
authors.lastname: Iedema
authors.forename: Lingzhi
authors.initials: L
authors.lastname: Kong
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
authors.forename: Shuguang
authors.initials: S
authors.lastname: Lin
authors.forename: Weifeng
authors.initials: W
authors.lastname: Shen
authors.forename: Dejia
authors.initials: D
authors.lastname: Huang
authors.forename: Yuejing
authors.initials: Y
authors.lastname: Yang
authors.forename: Junbo
authors.initials: J
authors.lastname: Ge
authors.forename: Yaling
authors.initials: Y
authors.lastname: Han
authors.forename: Shuzheng
authors.initials: S
authors.lastname: Lv
authors.forename: Aiqun
authors.initials: A
authors.lastname: Ma
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D055502:Secondary Prevention; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: acute coronary syndrome; clinical pathways