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Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome

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机构： [1]Capital Med Univ, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing An Zhen Hosp, Dept Epidemiol, 2 Anzhen Rd, Beijing 100029, Peoples R China; [2]Univ N Carolina, Div Cardiol, Chapel Hill, NC USA; [3]Peking Univ First Hosp, Dept Cardiol, Beijing, Peoples R China; [4]Univ Calif Los Angeles, Geffen Sch Med, Los Angeles, CA USA; [5]Capital Med Univ, Beijing An Zhen Hosp, Dept Cardiol, Beijing, Peoples R China; [6]Fudan Univ, Shanghai Inst Cardiovasc Dis, Zhongshan Hosp, Dept Cardiol, Shanghai, Peoples R China; [7]Amer Heart Assoc, Dept Global Strategies, Dallas, TX USA; [8]Amer Heart Assoc, Int Qual Improvement Dept, Dallas, TX USA

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Background A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical practice. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby improving clinical outcomes for ACS patients in China. Methods and Results The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle improvement, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and improve cardiovascular health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in -hospital outcomes, and discharge medications for secondary prevention. Improvement in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. Conclusions The CCC-ACS is a national hospital-based quality improvement program, aiming to increase adherence to ACS guidelines in China and improve patient outcomes.

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In total, 150 public tertiary hospitals participated in the project, with 75 centers in each of the 2 phases. Among them, 96 (64%) hospitals are from provincial capitals and municipalities, whereas the other 54 (36%) are from prefecture level cities. Most participating centers are located in either East (30%) or North China (17%). The remaining centers are split equally geographically among South, Southwest, Northwest, Northeast, and Central China. Participating hospitals from phase 1 and phase 2 began to report eligible ACS cases starting in November 2014 and May 2015, respectively. As of April 16, 2016, 35,616 ACS cases have been enrolled. presents the baseline demographic and clinical characteristics of the overall population, which includes STEMI (64%), NSTEMI (24%), and UAP patients (12%). Men represent 75% of the enrolled ACS patients. Clinical laboratories of participating hospitals received certification from an external quality assessment organization authorized by the National Health and Family Planning Commission of the People's Republic of China. All participating centers measured troponin for ACS patients during hospitalization. Among them, 85% tested troponin I and 40% hospitals tested troponin T. For hospitals testing troponin I and troponin T, 40% and 67% used high-sensitivity troponin assays respectively. In addition, 99% hospitals tested creatine kinase-MB for ACS inpatients. There were 7.5% of patients who had one or more PCI procedures before the index ACS admission, 7.9% who had a prior episode of myocardial infarction, 2.4% who had chronic heart failure, 10.2% who had a prior stroke, and 2.6% who had a history of atrial fibrillation. Table IV The overall quality of care for the cohort of patients enrolled to date by the composite performance measure score was 76.6%. The quality of care varied between hospitals ( ), with composite scores ranging from 49.9% to 90.3%. A total of 101 (67%) hospitals achieved a composite score less than 80%, indicating that more than 20% possible interventions among eligible patients were not performed in these hospitals. The primary performance measures across hospitals for baseline are presented in Supplementary Tables VII and VIII. Data for quality reports are exported for analysis on the 16th of each month, and quality reports are uploaded on the CCC Web site ( Figure 2 www.ccc-heart.com ) on the 22nd of each month. Quality reports on ACS for November 2014 to March 2016 have been uploaded to the Web site. The CCC project is a program of the AHA and the CSC. The AHA has been funded by Pfizer for quality improvement initiative through an independent grant for learning and change. Pfizer provided no oversight on the goals, execution, or publication of the program. 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.

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出版当年[2015]版：

大类 | 2 区医学

小类 | 2 区心脏和心血管系统

最新[2023]版：

大类 | 2 区医学

小类 | 3 区心脏和心血管系统

JCR分区：

出版当年[2014]版：

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

最新[2023]版：

Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

影响因子： 3.7 最新[2023版] 3.6 最新五年平均 4.463 出版当年[2014版] 4.395 出版当年五年平均 4.555 出版前一年[2013版] 4.332 出版后一年[2015版]

第一作者：

第一作者机构： [1]Capital Med Univ, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing An Zhen Hosp, Dept Epidemiol, 2 Anzhen Rd, Beijing 100029, Peoples R China;

通讯作者：

通讯机构： [1]Capital Med Univ, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing An Zhen Hosp, Dept Epidemiol, 2 Anzhen Rd, Beijing 100029, Peoples R China;

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