TY - JOUR
T1 - A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes
T2 - Rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial
AU - Berwanger, Otávio
AU - Guimarães, Hélio P.
AU - Laranjeira, Ligia N.
AU - Cavalcanti, Alexandre B.
AU - Kodama, Alessandra
AU - Zazula, Ana Denise
AU - Santucci, Eliana
AU - Victor, Elivane
AU - Flato, Uri A.
AU - Tenuta, Marcos
AU - Carvalho, Vitor
AU - Mira, Vera Lucia
AU - Pieper, Karen S.
AU - Mota, Luiz Henrique
AU - Peterson, Eric D.
AU - Lopes, Renato D.
N1 - Funding Information:
This trial is registered at clinicaltrials.gov (NCT00958958). 14 Funding for this study was provided by the Brazilian Ministry of Health (Projeto Hospitais de Excelencia a Serviço do SUS–PROADI). The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.
Funding Information:
Role of the funding source: This study is funded by the Brazilian Ministry of Health in Partnership with Hospital do Coracao (HCor)—Programa Hospitais de Excelencia a Servico do Sus (PROADI-SUS). The funding source has no role in the design, execution, analysis, and decision to publish the results.
PY - 2012/3
Y1 - 2012/3
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ahj.2012.02.004
DO - 10.1016/j.ahj.2012.02.004
M3 - Article
C2 - 22424001
AN - SCOPUS:84858326739
SN - 0002-8703
VL - 163
SP - 323-329.e1
JO - American heart journal
JF - American heart journal
IS - 3
ER -