Hospital do Coração, São Paulo, SP, Brasil.
Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Arq Bras Cardiol. 2020 Jul;115(1):92-99. doi: 10.36660/abc.20190393. Epub 2020 Aug 7.
Background There are substantial opportunities to improve the quality of cardiovascular care in developing countries through the implementation of a quality program. Objective To evaluate the effect of a Best Practice in Cardiology (BPC) program on performance measures and patient outcomes related to heart failure, atrial fibrillation and acute coronary syndromes in a subset of Brazilian public hospitals. Methods The Boas Práticas em Cardiologia (BPC) program was adapted from the American Heart Association's (AHA) Get With The Guidelines (GWTG) Program for use in Brazil. The program is being started simultaneously in three care domains (acute coronary syndrome, atrial fibrillation and heart failure), which is an approach that has never been tested within the GWTG. There are six axes of interventions borrowed from knowledge translation literature that will address local barriers identified through structured interviews and regular audit and feedback meetings. The intervention is planned to include at least 10 hospitals and 1,500 patients per heart condition. The primary endpoint includes the rates of overall adherence to care measures recommended by the guidelines. Secondary endpoints include the effect of the program on length of stay, overall and specific mortality, readmission rates, quality of life, patients' health perception and patients' adherence to prescribed interventions. Results It is expected that participating hospitals will improve and sustain their overall adherence rates to evidence-based recommendations and patient outcomes. This is the first such cardiovascular quality improvement (QI) program in South America and will provide important information on how successful programs from developed countries like the United States can be adapted to meet the needs of countries with developing economies like Brazil. Also, a successful program will give valuable information for the development of QI programs in other developing countries. Conclusions This real-world study provides information for assessing and increasing adherence to cardiology guidelines in Brazil, as well as improvements in care processes. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
通过实施质量项目，发展中国家有很大机会改善心血管护理质量。目的：评估最佳心脏病学实践（BPC）计划对巴西部分公立医院心力衰竭、心房颤动和急性冠状动脉综合征相关绩效指标和患者结局的影响。方法：Boas Práticas em Cardiologia（BPC）计划改编自美国心脏协会（AHA）的 Get With The Guidelines（GWTG）计划，用于巴西。该计划同时在三个护理领域（急性冠状动脉综合征、心房颤动和心力衰竭）启动，这是 GWTG 中从未测试过的方法。有六个干预轴来自知识转化文献，将通过结构化访谈和定期审核和反馈会议来解决确定的当地障碍。干预计划至少包括 10 家医院和 1500 例每种心脏病患者。主要终点包括总体遵守指南推荐的护理措施的比率。次要终点包括该计划对住院时间、总体和特定死亡率、再入院率、生活质量、患者健康感知和患者对规定干预措施的依从性的影响。结果：预计参与医院将提高和维持其整体对循证建议和患者结局的依从率。这是南美洲第一个此类心血管质量改进（QI）计划，将提供有关如何适应美国等发达国家成功计划以满足巴西等发展中经济体国家需求的重要信息。此外，一个成功的计划将为其他发展中国家制定 QI 计划提供有价值的信息。结论：本真实世界研究提供了评估和提高巴西心脏病学指南依从性以及改善护理过程的信息。（Arq Bras Cardiol. 2020; [在线]。提前印刷，PP.0-0）。
