Implementation of a Best Practice in Cardiology (BPC) Program Adapted from Get With The Guidelines®in Brazilian Public Hospitals: Study Design and Rationale

Abstract 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. 2019; xx(x):xxx-xxx)

摘要 背景：在发展中国家，通过实施质量改进项目可大幅提升心血管诊疗质量，此类优化空间十分可观。
目的：评估心血管最佳实践（Best Practice in Cardiology, BPC）项目对巴西部分公立医院中，与心力衰竭、心房颤动及急性冠脉综合征相关的诊疗绩效指标与患者临床结局的影响。
方法：本研究所用的心血管最佳实践（BPC）项目改编自美国心脏协会（American Heart Association, AHA）的《遵循指南》（Get With The Guidelines, GWTG）项目，以适配巴西的临床场景。该项目将同时覆盖三大诊疗领域（急性冠脉综合征、心房颤动及心力衰竭），这一实施模式此前从未在GWTG项目中得到验证。研究将借鉴知识转化（knowledge translation）领域文献中的六大干预维度，针对通过结构化访谈、定期审核与反馈会议所识别出的本地临床诊疗障碍开展干预。本计划拟纳入至少10家医院，每种心脏疾病队列纳入1500例患者。主要终点为指南推荐诊疗措施的总体依从率。次要终点包括项目对住院时长、总体死亡率与疾病特异性死亡率、再入院率、生活质量、患者健康认知水平及患者对医嘱干预措施依从性的影响。
结果：预计参与项目的医院可提升并维持其对循证医学推荐诊疗措施的总体依从率，同时改善患者临床结局。本项目为南美首个此类心血管质量改进（Quality Improvement, QI）项目，将为美国等发达国家的成熟质量改进项目如何适配巴西等发展中经济体国家的实际需求提供重要参考依据。此外，若项目取得成功，还将为其他发展中国家的心血管质量改进项目开发提供宝贵的实践经验。
结论：本真实世界研究（real-world study）可为评估并提升巴西心血管临床指南依从性、优化诊疗流程提供关键数据支撑。（Arq Bras Cardiol. 2019; xx(x):xxx-xxx）