Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). The 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. The primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS.

译文

将证据转化为急性冠脉综合征 (ACS) 治疗的临床实践具有挑战性。很少有ACS质量改善干预措施进行严格评估,以确定其对患者护理和临床结果的影响。我们设计了一项务实的,2臂,集群随机试验,涉及34个集群 (巴西公立医院).随机分组接受多方面质量改进干预 (实验组) 或常规实践 (对照组)。为期6个月的教育干预包括提醒,护理算法,案例管理员以及向医疗保健提供者分发教育材料。主要终点是入院24小时内基于证据的ACS后治疗,次要指标为主要心血管临床事件 (死亡,非致死性心肌梗死,非致死性心脏骤停和非致死性卒中).出院时循证疗法的处方也作为次要结局的一部分进行了评估。所有分析均按照意向治疗原则进行,并使用个体水平回归模型 (广义估计方程) 考虑了集群设计。如果证明有效,这种多方面的干预措施将被广泛用作促进最佳使用循证干预措施来管理ACS的手段。

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