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学科主题: 临床医学
题名:
Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China
作者: Li, Shenshen1; Wu, Yangfeng1,2; Du, Xin1,3; Li, Xian1; Patel, Anushka4; Peterson, Eric D.5; Turnbull, Fiona4; Lo, Serigne4; Billot, Laurent4; Laba, Tracey4; Gao, Runlin6,7,8; CPACS-3 Investigators Beijing
刊名: AMERICAN HEART JOURNAL
发表日期: 2015-03-01
DOI: 10.1016/j.ahj.2014.12.005
卷: 169, 期:3, 页:349-355
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Cardiac & Cardiovascular Systems
研究领域[WOS]: Cardiovascular System & Cardiology
关键词[WOS]: ELEVATION MYOCARDIAL-INFARCTION ; HEALTH SYSTEM REFORM ; PRACTICE GUIDELINES ; IMPROVING QUALITY ; MEDICAL THERAPY ; GLOBAL BURDEN ; CARE ; MANAGEMENT ; DISEASES ; IMPACT
英文摘要:

Background Acute coronary syndromes (ACSs) are a major cause of morbidity and mortality, yet effective ACS treatments are frequently underused in clinical practice. Randomized trials including the CPACS-2 study suggest that quality improvement initiatives can increase the use of effective treatments, but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered randomized controlled trial.

Design The CPACS-3 study is a stepped-wedge cluster-randomized trial conducted in 104 remote level 2 hospitals without PCI facilities in China. All hospitalized ACS patients will be recruited consecutively over a 30-month period to an anticipated total study population of more than 25,000 patients. After a 6-month baseline period, hospitals will be randomized to 1 of 4 groups, and a 6-component quality improvement intervention will be implemented sequentially in each group every 6 months. These components include the following: establishment of a quality improvement team, implementation of a clinical pathway, training of physicians and nurses, hospital performance audit and feedback, online technical support, and patient education. All patients will be followed up for 6 months postdischarge. The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality, myocardial infarction or reinfarction, and nonfatal stroke.

Conclusions The CPACS-3 study will be the first large randomized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes, in patients with ACS.

语种: 英语
WOS记录号: WOS:000351486800006
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/54396
Appears in Collections:北京大学临床研究所_期刊论文

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作者单位: 1.Peking Univ, Clin Res Inst, Beijing 100871, Peoples R China
2.Duke Univ, Med Ctr, Duke Clin Res Inst, Durham, NC USA
3.George Inst Global Hlth PUHSC, Beijing 700088, Peoples R China
4.Capital Med Univ, Beijing Anzhen Hosp, Beijing, Peoples R China
5.Univ Sydney, George Inst Global Hlth, Sydney, NSW 2006, Australia
6.Chinese Acad Med Sci, Cardiovasc Inst, Dept Cardiol, Beijing 100730, Peoples R China
7.Chinese Acad Med Sci, Fuwai Hosp, Beijing 100730, Peoples R China
8.Peking Union Med Coll, Beijing 100021, Peoples R China

Recommended Citation:
Li, Shenshen,Wu, Yangfeng,Du, Xin,et al. Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China[J]. AMERICAN HEART JOURNAL,2015,169(3):349-355.
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