Regional variations in clinical practices and outcomes of patients with acute coronary syndromes have been widely reported worldwide. Regional variations have been interpreted as a key factor leading to regional health disparities, but studies have yet to analyze how disparities can be reduced to promote quality equity. Quality improvement programs have shown some potential to improve patient quality inequities. However, whether the quality improvement program was associated with smaller regional variations in China with an aging population and increasing burden of ACS remained unknown. Research is urgently needed to generate evidence on the effect of quality improvement programs on regional variations with large-scale and nationally representative studies.

This study is the first large study with more than 1 million ACS patients to examine the regional variations through the whole chain of indicators, including pre-hospital emergency care,in-hospital treatment process, and patient outcomes in China. A quasi-experiment design with a longitudinal self-contrast comparison design before, during, and after the intervention was used to evaluate the effect of quality improvement programs on reducing regional variations in acute coronary syndromes. The findings indicated significant regional variations in the quality of services for patients with ACS. After the implementation of NCPCP, regional differences in in-hospital delays and invasive treatments have been smaller. However, there are still regional variations of quality indicators in pre-hospital delay, medication use, and in-hospital outcomes in China.

The concept of regional variations needs to be designed into the interventions from a systemic perspective, and more comprehensive interventions and hospital internal system optimizations are needed to further reduce the regional variations in the management and outcomes of patients with ACS. NCPCP should strengthen the construction of the whole emergency care system, for example, through the construction of chest pain units to construct the regional treatment networks. These findings may provide further impetus for hospitals involved in NCPCP to develop internal procedures to increase adherence to current guidelines.

See the article:

Regional Variations in Management and Outcomes of Patients with Acute Coronary Syndrome in China: Evidence from the National Chest Pain Center Program

https://doi.org/10.1016/j.scib.2024.03.010

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