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Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database
  1. Pengfei Sun1,
  2. Jianping Li1,
  3. Weiyi Fang2,
  4. Xi Su3,
  5. Bo Yu4,5,
  6. Yan Wang6,
  7. Chunjie Li7,
  8. Hu Chen8,
  9. Xingang Wang1,
  10. Bin Zhang1,
  11. Yuxi Li1,
  12. Mohetaboer Momin1,
  13. Ying Shi9,
  14. Haibo Wang10,
  15. Yan Zhang1,
  16. Dingcheng Xiang11,
  17. Yong Huo1
  1. 1Department of Cardiology, Peking University First Hospital, Beijing, China
  2. 2Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
  3. 3Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
  4. 4Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
  5. 5The Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, China
  6. 6Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen university, Xiamen, Fujian, China
  7. 7Emergency Department, Tianjin Chest Hospital, Tianjin, China
  8. 8Corporate Ethics Department, Bureau of Medical Administration National Health Commission of the People's Republic of China, Beijing, China
  9. 9China Standard Medical Information Research Center, Shenzhen, Guangdong, China
  10. 10Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
  11. 11Department of Cardiology, General Hospital of Southern Theatre Command of PLA, Guangzhou, Guangdong, China
  1. Correspondence to Dr Yan Zhang, Department of Cardiology, Peking University First Hospital, Beijing, China; drzhy1108{at}163.com; Dr Dingcheng Xiang; dcxiang{at}foxmail.com; Dr Yong Huo; huoyong{at}263.net.cn

Abstract

Background Large-scale real-world data to evaluate the impact of chest pain centre (CPC) accreditation on acute coronary syndrome (ACS) emergency care in heavy-burden developing countries like China are rare.

Methods This study is a retrospective study based on data from the Hospital Quality Monitoring System (HQMS) database. This study included emergency patients admitted with ACS to hospitals that uploaded clinical data continuously to the database from 2013 to 2016. Propensity score matching was used to compare hospitals with and without CPC accreditation during this period. A longitudinal self-contrast comparison design with mixed-effects models was used to compare management of ACS before and after accreditation.

Results A total of 798 008 patients with ACS from 746 hospitals were included in the analysis. After matching admission date, hospital levels and types and adjusting for possible covariates, patients with ACS admitted to accredited CPCs had lower in-hospital mortality (OR=0.70, 95% CI 0.53 to 0.93), shorter length of stay (LOS; adjusted multiplicative effect=0.89, 95% CI 0.84 to 0.94) and more percutaneous coronary intervention (PCI) procedures (OR=3.53, 95% CI 2.20 to 5.66) than patients admitted in hospitals without applying for CPC accreditation. Furthermore, when compared with the ‘before accreditation’ group only in accredited CPCs, the in-hospital mortality and LOS decreased and the usage of PCI were increased in both ‘accreditation’ (for in-hospital mortality: OR=0.86, 95% CI 0.79 to 0.93; for LOS: 0.94, 95% CI 0.93 to 0.95; for PCI: OR=1.22, 95% CI 1.18 to 1.26) and ‘after accreditation’ groups (for in-hospital mortality: OR=0.90, 95% CI 0.84 to 0.97; for LOS: 0.89, 95% CI 0.89 to 0.90; for PCI: OR=1.36, 95% CI 1.33 to 1.39). The significant benefits of decreased in-hospital mortality, reduced LOS and increased PCI usage were also observed for patients with acute myocardial infarction.

Conclusions CPC accreditation is associated with better management and in-hospital clinical outcomes of patients with ACS. CPC establishment and accreditation should be promoted and implemented in countries with high levels of ACS.

  • healthcare quality improvement
  • medical emergency team
  • teamwork
  • quality improvement

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Footnotes

  • Contributors All authors meet the ICMJE recommendations for authorship and agree to be accountable for all aspects All authors meet the ICMJE recommendations for authorship and agree to be accountable for all aspects of the work. Yong Huo, Yan Zhang and Jianping Li contributed to the design and revising of the work; Pengfei Sun contributed to the acquisition, analysis, or interpretation of data for the work and drafting of the work. Haibo Wang, Hu Chen, Dingcheng Xiang, Weiyi Fang, Xi Su, Bo Yu, Yan Wang, Chunjie Li and Ying Shi contributed to the final approval of the version to be published. Xingang Wang, Bin Zhang, Yuxi Li and Min Mo contributed to acquisition of data.The authors thank Headquarters of China Chest Pain Centres and the China Standard Medical Information Research Centre for their help and support throughout the study.

  • Funding This study was funded by China-WHO Biennial Collaborative Projects 2016-2017 (design and collection parts).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was authorised by the Hospital Quality Monitoring System Committee Board and approved by the ethics committee of Peking University First Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from China Standard Medical Information Research Center but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of China Standard Medical Information Research Center.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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