Coronary Artery Bypass Grafting (CABG)
Conditions
Keywords
coronary artery bypass grafting, quality improvement, arterial graft
Brief summary
This is a healthcare quality improvement study focused on increasing the utilization of arterial grafts in isolated coronary artery bypass grafting (CABG). Evidence indicates that arterial grafts, compared with venous grafts, provide superior long-term patency, which are recommended to use by the clinical practice guidelines. In hospitals where the use of the internal mammary artery as a graft is relatively low(\<90%) among CABG patients, multiple interventions will be implemented to improve its adoption rate. In hospitals where internal mammary artery graft utilization is already high(≥90%), various interventions will be introduced to promote the use of multiple arterial grafts (defined as the use of two or more arterial conduits). The study targets healthcare professionals as the primary subjects of intervention, with no direct interventions applied to patients during the study period. Changes in the internal mammary artery graft utilization rate and the multiple arterial graft utilization rate before and after the intervention will serve as the primary endpoints for evaluating intervention effectiveness in the two types of hospitals, respectively.
Interventions
BEHAVIORALInterventions for healthcare professionals in hospitals with low usage rates
Hospitals with low usage rates aim to improve internal mammary artery graft utilization through interventions including education, theoretical training, technical training, conference exchanges, and regular feedback on quality monitoring results.
BEHAVIORALInterventions for healthcare professionals in hospitals with high usage rates
Hospitals with already high usage rates focus on increasing multi-arterial graft usage rates through similar intervention methods such as education, theoretical training, technical training, conference exchanges focus on multi-arterial graft use. The usage rates of multi-arterial graft for each hospital will be regular feed backed.
Sponsors
China National Center for Cardiovascular Diseases
Chinese Academy of Medical Sciences, Fuwai Hospital
Shandong Provincial Hospital
The First Affiliated Hospital with Nanjing Medical University
Guangdong Provincial People's Hospital
Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
West China Hospital
First Affiliated Hospital of Wenzhou Medical University
Ruijin Hospital
The General Hospital of Northern Theater Command
Central China Fuwai Hospital of Zhengzhou University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
This is a stepped-wedge cluster randomized trial (SW-CRT) with a self-controlled design. Hospitals were categorized into two groups based on their internal mammary artery graft usage rates (low or high), forming two SW-CRT.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients whose data used to monitor the quality Inclusion Criteria: Aged ≥ 18 years old； Indicated for CABG and undergoing CABG.
Exclusion criteria
History of prior CABG; Concurrent other cardiac surgeries on the day of CABG; Malignant tumor or life expectancy \< 1 year; * 50% stenosis of left subclavian artery; Pregnant women; Individuals diagnosed with mental illness or cognitive impairment (International Classification of Diseases-10 codes F01-F99); Patients considered by the investigator to have other factors unsuitable for inclusion.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hospitals with low usage rates of internal mammary artery: internal mammary artery graft utilization rate | Duration of hospital stay(from date of admission to date of discharge) | Internal mammary artery graft utilization rate: the utilization rate of at least one internal mammary artery graft in patients received isolated coronary artery bypass grafting. |
| Hospitals with high usage rates of internal mammary artery: multiple arterial graft utilization rate | Duration of hospital stay(from date of admission to date of discharge) | Multiple arterial graft utilization rate: the utilization rate of two or more arterial conduits in patients received isolated coronary artery bypass grafting. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| In-hospital all-cause mortality rate | Duration of hospital stay(from date of admission to date of discharge) | The in-hospital all-cause mortality rate of patients received isolated coronary artery bypass grafting. |
Contacts
CONTACTZhe Zheng, MD, PhD
Outcome results
None listed