National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; Department of Cardiothoracic Surgery, Shenzhen Children's Hospital, Shenzhen, China.
Am Heart J. 2021 Jul;237:79-89. doi: 10.1016/j.ahj.2021.03.005. Epub 2021 Mar 6.
Studies found that patients who underwent coronary artery bypass grafting (CABG) often fail to receive optimal evidence-based secondary prevention medications. We evaluated the effectiveness of a smartphone-based quality improvement effort on improving the prescription of medical therapies.
In this cluster-randomized controlled trial, 60 hospitals were randomized to a control arm (n = 30) or to an intervention arm using smartphone-based multifaceted quality improvement interventions (n = 30). The primary outcome was the prescription of statin. The secondary outcomes were prescription of beta-blocker, angiotensin-converting enzyme inhibitor, or angiotensin receptor blocker (ACE inhibitor or ARB), and optimal medical therapy for eligible patients.
Between June 1, 2015 and September 15, 2016, a total of 10,006 CABG patients were enrolled (5,653 in 26 intervention and 4,353 in 29 control hospitals, 5 hospitals withdrew). Statin prescribing rate was 87.8% in the intervention arm and 84.4% in the control arm. We saw no evidence of an effect of intervention on statin prescribing in the intention-to-treat analysis (odds ratio [OR], 1.31; 95% confidence interval (CI), 0.68-2.54; P = .43) or in key patient subsets. The prescription rates of ACE inhibitor or ARB and optimal medical therapy were comparable between study groups, while beta-blocker was more often prescribed in the intervention arm. Post hoc analysis demonstrated a greater increase in statin prescribing rate over time in the intervention arm.
A smartphone-based quality improvement intervention compared with usual care did not increase statin prescribing for patients who received CABG. New studies focusing on the best practice of this technique may be warranted.
研究发现，接受冠状动脉旁路移植术（CABG）的患者往往无法接受最佳的循证二级预防药物治疗。我们评估了基于智能手机的质量改进措施在改善医疗治疗方案方面的有效性。
在这项聚类随机对照试验中，将 60 家医院随机分为对照组（n=30）或干预组（n=30），干预组采用基于智能手机的多方面质量改进措施。主要结局是他汀类药物的处方情况。次要结局包括β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂（ACEI 或 ARB）的处方情况，以及适合患者的最佳药物治疗。
2015 年 6 月 1 日至 2016 年 9 月 15 日，共纳入 10006 例 CABG 患者（26 家干预医院 5653 例，29 家对照组医院 4353 例，5 家医院退出）。干预组他汀类药物的处方率为 87.8%，对照组为 84.4%。意向治疗分析（比值比[OR]，1.31；95%置信区间[CI]，0.68-2.54；P=0.43）或关键患者亚组均未显示干预对他汀类药物处方的影响。ACEI 或 ARB 和最佳药物治疗的处方率在研究组之间相似，而干预组更常开β受体阻滞剂。事后分析表明，干预组的他汀类药物处方率随时间推移呈上升趋势。
与常规护理相比，基于智能手机的质量改进干预措施并未增加接受 CABG 治疗的患者的他汀类药物处方。可能需要新的研究来关注该技术的最佳实践。
