Hospital TotalCor, São Paulo, Brazil.
Hospital TotalCor, São Paulo, Brazil.
Int J Cardiol. 2018 Sep 15;267:13-15. doi: 10.1016/j.ijcard.2018.05.102. Epub 2018 May 26.
The National Cardiovascular Data Registry (NCDR®) Database is commonly used for quality-improvement initiatives in North America, but little is known about the application of this tool in other regions of the world.
All consecutive patients admitted due to myocardial infarction (MI) and/or undergoing percutaneous coronary intervention (PCI) from January 2012 until December 2015 in a Brazilian private cardiovascular hospital were included respectively in ACTION REGISTRY®-GWTG™ and CathPCI Registry®. Meetings including all hospital staff were performed quarterly to discuss every NCDR® report. Quality improvement initiatives were developed based on the reports which were also used for evaluation of changes after the interventions. The following indicators were considered a priority 1) Door-to-ECG and door-to-balloon (D2B) times; 2) PCI appropriateness; 3) length of stay; 4) delivery of guideline-based medication. Changes in the quality of care with respect to the over time were assessed using linear and logistic regression for continuous and binary outcomes, respectively.
A total of 1.382 patients were included in the ACTION REGISTRY®-GWTG™ and 3.179 patients in the CathPCI Registry®. In the ACTION registry, the overall AMI performance composite of quality indicators improved along the 4 years from 95.0% to 99.6% (p for trend <0.001). The percentage of appropriate/uncertain PCI in acute and elective scenario increased along the years from 91.1% and 70.9% to 96.6% and 84.7%, respectively (p for trend <0.001).
The present novel experience using the NCDR® registries as benchmarks to guide quality-improvement programs in an international site was associated with improvement in quality indicators.
国家心血管数据注册中心（NCDR®）数据库常用于北美地区的质量改进计划，但对于该工具在世界其他地区的应用知之甚少。
从 2012 年 1 月至 2015 年 12 月，巴西一家私立心血管医院连续收治的因心肌梗死（MI）和/或经皮冠状动脉介入治疗（PCI）的所有患者分别纳入 ACTION REGISTRY®-GWTG™ 和 CathPCI Registry®。每季度举行一次包括所有医院工作人员在内的会议，讨论 NCDR®报告的每一个方面。根据报告制定质量改进措施，并在干预后评估变化情况。以下指标被视为优先考虑的重点：1）门到心电图和门到球囊（D2B）时间；2）PCI 的适宜性；3）住院时间；4）基于指南的药物的使用。使用线性和逻辑回归分别评估连续和二进制结果的随时间变化的护理质量变化。
ACTION REGISTRY®-GWTG™ 共纳入 1382 例患者，CathPCI Registry®共纳入 3179 例患者。在 ACTION 注册中心，4 年内，质量指标的整体 AMI 表现综合从 95.0%提高到 99.6%（趋势 p<0.001）。急性和择期情况下，适当/不确定 PCI 的比例逐年从 91.1%和 70.9%增加到 96.6%和 84.7%（趋势 p<0.001）。
本研究采用 NCDR®注册中心作为基准，指导国际站点的质量改进计划，这一新颖的经验与质量指标的改善相关。
