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)

Flather, Marcus D., Babalis, Daphne, Booth, Jean, Bardaji, Alfredo, Machecourt, Jacques, Opolski, Grzegorz, Ottani, Filippo, Bueno, Héctor, Banya, Winston, Brady, Anthony R., Bojestig, Mats and Lindahl, Bertil (2011) 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). American Heart Journal, 162 (4). 700-707.e1. ISSN 1097-6744

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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.

Item Type: Article
Additional Information: Copyright © 2011 Mosby, Inc. All rights reserved.
Uncontrolled Keywords: acute coronary syndrome,aged,cluster analysis,female,humans,male,outcome and process assessment (health care),prospective studies,quality improvement
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Rhiannon Harvey
Date Deposited: 29 Feb 2012 15:21
Last Modified: 02 Oct 2022 00:44
URI: https://ueaeprints.uea.ac.uk/id/eprint/37694
DOI: 10.1016/j.ahj.2011.07.027

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