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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)
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2011 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 162, no 4, 700-707.e1 p.Article in journal (Refereed) Published
Abstract [en]

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, beta-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.

Place, publisher, year, edition, pages
2011. Vol. 162, no 4, 700-707.e1 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-161056DOI: 10.1016/j.ahj.2011.07.027ISI: 000295925100020OAI: oai:DiVA.org:uu-161056DiVA: diva2:456418
Available from: 2011-11-14 Created: 2011-11-07 Last updated: 2011-11-16Bibliographically approved

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Lindahl, Bertil
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UCR-Uppsala Clinical Research CenterDepartment of Medical Sciences
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