03250nas a2200601   4500000000100000008004100001653001000042653001100052653001100063653000900074653000900083653001600092653001500108653001000123653002800133653001600161653003300177653002200210653002300232653002400255653002800279653004900307653003600356653002500392100001900417700002400436700001100460700001600471700001500487700001200502700002100514700001500535700001500550700001900565700001200584700001600596700001700612700001700629700001700646700001600663700001700679700001300696700001500709700001600724700001300740700001200753700001800765245013700783300001100920490000600931520169700937022001402634       2014                            d10aAdult10aFemale10aHumans10aAged10aMale10aMiddle Aged10aAdolescent10aChina10aEvidence-Based Medicine10aYoung Adult10aPractice Guidelines as Topic10aSurvival Analysis10aProgram Evaluation10aQuality Improvement10aAcute Coronary Syndrome10aOutcome and Process Assessment (Health Care)10aPlatelet Aggregation Inhibitors10aSecondary Prevention1 aTurnbull Fiona1 aCPACS Investigators1 aDu Xin1 aWu Yangfeng1 aGao Runlin1 aHu Dayi1 aRanasinghe Isuru1 aLo Serigne1 aHao Zhixin1 aBillot Laurent1 aRong Ye1 aIedema Rick1 aKong Lingzhi1 aLin Shuguang1 aShen Weifeng1 aHuang Dejia1 aYang Yuejing1 aGe Junbo1 aHan Yaling1 aLv Shuzheng1 aMa Aiqun1 aGao Wei1 aPatel Anushka00aHospital quality improvement initiative for patients with acute coronary syndromes in China: a cluster randomized, controlled trial.  a217-260 v73 a<p>
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 &gt;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.
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