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Title: Is Quality Improvement for treatment of acute coronary syndromes worthwhile? : results from the EQUIP-ACS trial
Author: Babalis, Daphne
ISNI:       0000 0004 7233 0914
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2015
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This thesis constitutes an assessment of a Quality Improvement (QI) programme delivered to healthcare professionals managing patients with non-ST elevation Acute Coronary Syndromes (ACS). This is a mixed methods evaluation of a QI programme encompassing a range of quantitative analyses and a qualitative semi-structured interview programme. Data from ACS registries demonstrate that management of non-ST elevation ACS is sub-optimal with respect to guideline recommendations. A range of interventions such as educational programmes, financial incentives and publication of performance have been implemented in healthcare showing evidence of improved standards of care. Whilst these results are encouraging, further research is needed to understand the factors that facilitate improvement and whether results achieved are sustained. The European Quality Improvement Programme for Acute Coronary Syndromes (EQUIP-ACS) project was a cluster-randomised QI programme for healthcare professionals delivered to 38 hospitals in five European countries. Data for 2,582 non-ST elevation ACS admissions were entered onto a web-based database over approximately 12 months. The primary outcome was a composite of eight guideline-recommended treatments for ACS compared before and after delivery of the QI intervention. Additional exploratory analyses have been performed to assess: the use of risk stratification methods and effect of patient risk, effect of patient and hospital characteristics, long term results of the QI intervention and a qualitative evaluation based on semi-structured interviews conducted with healthcare professionals. The EQUIP-ACS QI intervention led to increased use of ACS treatments. Improvement achieved was not consistent across all patients however and those with comorbidities received poorer management. Use of risk stratification was independently associated with improved management. Improvement was sustained at two of the centres one year after the programme, although a trend for decline over time was observed. Qualitative interviews revealed a range of factors that may influence delivery of QI and should be considered for future QI programmes.
Supervisor: Cowie, Martin ; Flather, Marcus Sponsor: Royal Brompton and Harefield NHS Foundation Trust ; GlaxoSmithKline
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral