Coronary Artery Bypass Grafting, Secondary Preventions
Conditions
Keywords
coronary artery bypass grafting, quality improvement, secondary preventions
Brief summary
The investigators have identified underuse of secondary prevention medications at discharge of patients underwent coronary artery bypass grafting (CABG) in China. The aim of this study is to develop series of quality improvement strategies focusing on secondary prevention medications for patients underwent CABG, and to evaluate their effectiveness and safety via a hospital-level cluster randomized clinical trial. The investigators established a network of 60 hospitals which have participated into Chinese Cardiovascular Surgery Registry and submitted 50 or more CABG surgeries already. The participating sites will be divided into intervention and control groups in a 1:1 ratio. The intervention group will undertake intervention of quality improvement strategies, while the control group will maintain the routine practice pattern. All hospitals will consecutively enroll and submit data of CABG during the enrollment period, estimated for 6 months. The prescribing rates of angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blockers, statins and aspirins will be compared between 2 groups.
Detailed description
The investigators have identified underuse of secondary prevention medications at discharge of patients underwent coronary artery bypass grafting (CABG) in China. The aim of this study is to develop series of quality improvement strategies focusing on secondary prevention medications for patients underwent CABG, and to evaluate their effectiveness and safety via a hospital-level cluster randomized clinical trial. The investigators established a network of 60 hospitals which have participated into Chinese Cardiovascular Surgery Registry and submitted 50 or more CABG surgeries already. The participating sites will be divided into intervention and control groups in a 1:1 ratio. The intervention group will undertake intervention of quality improvement strategies, while the control group will maintain the routine practice pattern. All hospitals will consecutively enroll and submit data of CABG during the enrollment period of estimated 6 months. The prescription rates of ACEI, ARB, beta-blockers, statins and aspirins will be compared between 2 groups. Before the enrollment period, the investigators have developed series of quality improvement strategies focusing on secondary prevention medications for patients underwent CABG, including training with guidelines of secondary preventions, determining improvement goals with participating sites, intervention tools (workflow posters and cards, checklists to inform the use of secondary prevention medications) and periodical quality feedback reports. In the enrollment period, participating hospitals will be divided into intervention and control groups in a 1:1 ratio using minimization allocation. The investigators will collect data on the prescription rates from central medical record abstraction, case report forms submitted by participating sites and checklists submitted by intervention groups.
Interventions
BEHAVIORALQuality improvement strategies
Training with guidelines of secondary preventions; determining improvement goals; tools (workflow posters and cards, checklists to inform the use of secondary prevention medications); periodical quality feedback report.
Sponsors
China National Center for Cardiovascular Diseases
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Masking description
Outcomes assessor and data extractors were blind to the results of randomization
Intervention model description
The study was a cluster randomized controlled trial to test the effectiveness of a smartphone-based multifaceted intervention. Sixty hospitals were randomized to the intervention group (n=30) or control group (n=30). Clinicians at intervention hospitals received multifaceted interventions (i.e., centralized training, evidenced-based checklists, and performance monitoring and feedback report) aimed at improving discharge prescription adherence, while those at control hospitals maintained routine practice.
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Patients underwent CABG during the enrollment period in participating sites
Exclusion criteria
* Patients who die during hospitalization * Patients who withdrawn from hospital against doctors' recommendations * Patients who transfer out to other medical care institutions without discharge prescription
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| statins use at discharge | 14 days on average (during hospitalization) | Proportion of statins prescription at discharge among eligible patients |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ACEI/ARBs use at discharge | 14 days on average (during hospitalization) | Proportion of β-blockers prescription at discharge among eligible patients |
| β-blockers use at discharge | 14 days on average (during hospitalization) | Proportion of β-blockers prescription at discharge among eligible patients |
| aspirins use at discharge | 14 days on average (during hospitalization) | Proportion of aspirins prescription at discharge among eligible patients |
Other
| Measure | Time frame | Description |
|---|---|---|
| education on smoking cessation at discharge | 14 days on average (during hospitalization) | Proportion of education on smoking cessation at discharge among eligible patients |
| education on glycemic control at discharge | 14 days on average (during hospitalization) | Proportion of education on glycemic control at discharge among eligible patients |
| education on moderate exercise at discharge | 14 days on average (during hospitalization) | Proportion of education on moderate exercise at discharge among eligible patients |
| education on weight control at discharge | 14 days on average (during hospitalization) | Proportion of education on weight control at discharge among eligible patients |
Countries
China
Outcome results
None listed