Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
Institute for Global Health and Development, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
Implement Sci. 2022 Jun 1;17(1):36. doi: 10.1186/s13012-022-01207-6.
Ischemic heart disease causes a high disease burden globally and numerous challenges in treatment, particularly in developing countries such as China. The National Chest Pain Centers Program (NCPCP) was launched in China as the first nationwide, hospital-based, comprehensive, continuous quality improvement (QI) program to improve early diagnosis and standardized treatment of acute coronary syndromes (ACS) and improve patients' clinical outcomes. With implementation and scaling up of the NCPCP, we investigated barriers and enablers in the NCPCP implementation process and provided examples and ideas for overcoming such barriers.
We conducted a nationally representative survey in six cities in China. A total of 165 key informant interviewees, including directors and coordinators of chest pain centers (CPCs) in 90 hospitals, participated in semi-structured interviews. The interviews were transcribed verbatim, translated into English, and analyzed in NVivo 12.0. We used the Consolidated Framework for Implementation Research (CFIR) to guide the codes and themes.
Barriers to NCPCP implementation mainly arose from nine CFIR constructs. Barriers included the complexity of the intervention (complexity), low flexibility of requirements (adaptability), a lack of recognition of chest pain in patients with ACS (patient needs and resources), relatively low government support (external policies and incentives), staff mobility in the emergency department and other related departments (structural characteristics), resistance from related departments (networks and communications), overwhelming tasks for CPC coordinators (compatibility), lack of available resources for regular CPC operations (available resources), and fidelity to and sustainability of intervention implementation (executing). Enablers of intervention implementation were inner motivation for change (intervention sources), evidence strength and quality of intervention, relatively low cost (cost), individual knowledge and beliefs regarding the intervention, pressure from other hospitals (peer pressure), incentives and rewards of the intervention, and involvement of hospital leaders (leadership engagement, engaging).
Simplifying the intervention to adapt routine tasks for medical staff and optimizing operational mechanisms between the prehospital emergency system and in-hospital treatment system with government support, as well as enhancing emergency awareness among patients with chest pain are critically important to NCPCP implementation. Clarifying and addressing these barriers is key to designing a sustainable QI program for acute cardiovascular diseases in China and similar contexts across developing countries worldwide.
This study was registered in the Chinese Clinical Trial Registry ( ChiCTR 2100043319 ), registered 10 February 2021.
缺血性心脏病在全球范围内造成了很高的疾病负担，在治疗方面也面临着诸多挑战，尤其是在中国等发展中国家。国家胸痛中心项目（NCPCP）作为首个全国性的、以医院为基础的、全面的、持续质量改进（QI）项目，旨在改善急性冠状动脉综合征（ACS）的早期诊断和规范化治疗，改善患者的临床结局。随着 NCPCP 的实施和推广，我们调查了 NCPCP 实施过程中的障碍和促进因素，并提供了克服这些障碍的范例和思路。
我们在中国六个城市进行了一项全国代表性调查。共有 165 名关键知情者接受了采访，包括 90 家医院胸痛中心（CPC）的主任和协调员。访谈采用半结构式进行，逐字记录，并翻译成英文，然后在 NVivo 12.0 中进行分析。我们使用整合实施研究框架（CFIR）来指导编码和主题。
NCPCP 实施的障碍主要来自九个 CFIR 结构。障碍包括干预措施的复杂性（复杂性）、要求的适应性低（适应性）、ACS 患者对胸痛的认识不足（患者需求和资源）、政府支持相对较低（外部政策和激励措施）、急诊科和其他相关部门人员流动（结构特征）、相关部门的抵制（网络和沟通）、CPC 协调员的任务繁重（兼容性）、CPC 常规运作的可用资源不足（可用资源）、以及干预措施的执行和可持续性（执行）。干预实施的促进因素包括对变革的内在动力（干预来源）、干预措施的证据强度和质量、相对较低的成本（成本）、个人对干预措施的知识和信念、来自其他医院的压力（同行压力）、干预措施的激励和奖励，以及医院领导的参与（领导参与、参与）。
简化干预措施，使医务人员适应常规任务，优化院前急救系统与院内治疗系统之间的运作机制，并加强胸痛患者的急救意识，对于 NCPCP 的实施至关重要。明确和解决这些障碍是在中国和全球发展中国家设计急性心血管疾病持续质量改进计划的关键。
