Improving Care for Cardiovascular Disease in China: A collaborative project of AHA and CSC (The CCC Project) Project Progress

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1 Improving Care for Cardiovascular Disease in China: A collaborative project of AHA and CSC (The CCC Project) Project Progress Beijing Anzhen Hospital, Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases

2 Landmark Events Meeting Data Education 03/ st SMG meeting 09/2014 Launching meeting 10/ nd SMG meeting 1 st training course 11/2014 ACS Phase 1 began 02/2015 AF Phase 1 began 03/ rd SMG meeting 2 nd training course 05/2015 ACS Phase 2 began 1 st webinar 06/2015 ACS: /2015 AF Phase 2 began 09/2015 ACS: st recognition meeting 12/2015 AF: st regional workshop 01/2016 ACS: nd webinar 02/ th SMG meeting 3 rd webinar 05/ nd regional workshop 09/2016 ACS: 45000,AF: nd recognition meeting 07/2017 ACS: 62694,AF: nd training course 2

3 Infrastructure Set-up The CCC website Electronic data collection (EDC) system WeChat official accounts and groups Web-based education platform (webinar) ly feedback system for quality of care Regional workshop Annual recognition meeting 3

4 CCC Website: 4

5 Electronic Data Collection System Oracle OC/RDC database 5

6 Official WeChat Accounts and Groups 6

7 Web-based Education Platform (webinar) Know your reports Early administration of beta blockers in patients with ACS Risk assessment and anticoagulant therapy in patients with atrial fibrillation 7

8 Achievements of Scientific Research List of SCI papers Type Title Journal Protocol Protocol (revised) Result Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) Project: A national effort to improve management of atrial fibrillation Invasive management strategies and antithrombotic treatments in patients with non-st-segment-elevation acute coronary syndrome in China Am Heart J Circ Cardiovasc Qual Outcomes Circ Cardiovasc Intervention 4 Abstracts were accepted in the International Conference: 2 in AHA annual meeting, 1 in ACC annual meeting, and 1 in Global health systems Symposium 8

9 Up-to-date results Nov. 1 st, 2014 May 31 st, 2017 Hospital enrollment Case recruitment and performance measures for ACS Case recruitment and performance measures for AF 9

10 Hospital Enrollment 150 tertiary hospitals were recruited Northern China Northeast China Eastern China Central China Southern China Southwest China Eastern China Second Level hospital: 42 Region Northern China Northeast China Eastern China Central China Southern China Southwest China Northwest China Hospital sampling frame stratified by geographic-economic level Economic level Provinces No. of hospitals in the area # No. of hospitals needed (10) Enrolled hospitals in phase 1 Enrolled hospitals in phase 2 Low NA Medium-low Shanxi Total Medium-high Hebei High Beijing, Tianjin, Inner Mongolia Low NA Medium-low Heilongjiang Medium-high Jilin High Liaoning Low Anhui, Jiangxi Medium-low NA Medium-high Fujian, Shandong High Shanghai, Jiangsu, Zhejiang Low NA Medium-low Henan, Hunan Medium-high Hubei High NA Low Guangxi Medium-low Hainan Medium-high NA High Guangdong Low Guizhou, Yunnan, Tibet Medium-low Sichuan Medium-high Chongqing High NA Low Gansu Medium-low Qinghai, Xinjiang Medium-high Shaanxi, Ningxia High NA Total

11 ACS Case Recruitment ACS cases have been reported (Nov, 2014-May, 2017) Male: cases, 75 Female: cases, 25 Males STEMI NSTEMI Females STEMI NSTEMI ,2 67,1 UAP 30, ,2 UAP 11

12 ACS Primary Performance Measures Early performances 1. Proportion of patients receiving aspirin at arrival (within 24 hours) 2. Proportion of STEMI patients ,3 receiving fibrinolytic therapy within 30 minutes after arrival among 80 79,1 those receiving this treatment 3. Proportion of STEMI patients 60 53,1 60,5 receiving primary PCI within 90 minutes after arrival among those receiving this treatment 40 27,5 4. Proportion of STEMI patients receiving reperfusion therapy Proportion of patients with evaluation for LV systolic function by echocardiography 0 Fibinolytics within 30 mins Primary PCI within 90 mins Reperfusion therapy Evaluation of LVSF Aspirin at arrival 12

13 ACS primary performance measures At discharge 6. Proportion of ACS patients receiving aspirin at discharge 7. Proportion of patients with ,1 92,4 96,4 indications receiving P2Y 12 receptor inhibitor at discharge 8. Proportion of patients with indications receiving a betablocker at discharge 9. Proportion of patients receiving a statin at discharge 10. Proportion of ACS patients with indications receiving an ACE-I or ARB at discharge 11. Proportion of smoking patients that receiving smoking cessation advice/ counseling ,0 Smoking cessation advice 57,3 ACE-I/ARB at discharge 66,2 Beta blocker at discharge Statin at discharge Aspirin at discharge P2Y12 at discharge 13

14 Composite Scores of ACS Primary Performance Measures ,5 75,2 80,9 76, I I I I ACS STEMI NSTEMI UAP Notes: numbers above the bars refer to composite scores of performance measures for all hospitals; numbers in the bars refer to the maximum and minimum values. 14

15 No. of hospitals National Distribution of Composite Scores of ACS Primary Performance Measures Composite scores of ACS primary performance measures 15

16 Trend of Composite Primary Performance Measures for ACS P for trend < ,2 76,0 76,1 77,5 76,1 79,2 75,2 78,1 79,4 Notes: numbers above the bars refer to composite scores of performance measures for all hospitals 16

17 Trend of Individual Primary Performance Measure for ACS -- Early Strategies Asprin at Arrival P = P = P = P <0.001 P = * Trend Chi-square test 17

18 Trend of Individual Primary Performance Measure for ACS -- At Discharge P = P = P = P = P = Smoking Cessation 100 P < * Trend Chi-square test 18

19 Downloading of The ly Quality Reports 17,3 Phase 1 hospitals 17,3 Phase 2 hospitals 72,7 Download Undownload 72,7 Download Undownload Phases No. of hospitals No. of reports Download rate () Phase Phase Total

20 Composite Scores of ACS Primary Performance Measures Improved Significantly in Hospitals which Downloaded Reports ,79 P <0.001 P = ,18 77,62 77,16 79,27 78, ,92 71,11 74,72 74,08 73,71 74, * Trend Chi-square test 20

21 AF Cases Recruitment AF cases have been reported (Feb, 2015-May, 2017) Male: cases, 55 Female: cases, 45 Male Female 10,6 19,4 89,4 NVAF VAF 80,6 NVAF VAF Notes: The cases included if the discharge diagnosis and date of discharge were filled in completely and correctly. 21

22 AF Primary Performance Measures 1. Proportion of patients with nonvalvular atrial fibrillation in whom assessment of 100 thromboembolic risk 2. Proportion of AF patients with indication 80 prescribed an anticoagulant drug at discharge 3. Proportion of patients discharged on warfarin who have PT/INR follow-up planned prior to hospital discharge Proportion of AF patients with indications receiving ACEI/ARB at discharge Proportion of AF patients with indication prescribed a beta blocker at discharge 6. Proportion of AF patients with indication prescribed a statin at hospital discharge 0 19,5 Assessment of thromboembolic risk 53,1 ACEI/ARB at discharge 55,8 57,6 Anticoagulant drug at discharge Beta blocker at discharge 61,3 Statin at hospital discharge 87,2 PT/INR followup 22

23 Composite Score of AF Performance Measures ,1 51, I 88.4 Composite score of primare performance measures 1.7 I 96.2 Composite score of secondary performance measures Notes: numbers above the bars refer to composite scores of performance measures for all hospitals; numbers in the bars refer to the maximum and minimum values. 23

24 No. of hospitals National Distribution of Composite Scores of AF Primary Performance Measures Composite scores of primary performance measures 24

25 National Distribution of Composite Scores of AF Secondary Performance Measures 医院数 综合达标率 25 阶段性结果, 仅供内部交流, 请勿引用

26 Trend of Composite Scores of Performance Measures for AF Primary performance measures Secondary performance measures P for trend < ,9 48,8 50,3 43,9 43,3 54,3 54,3 49, ,5 44,8 P for trend < ,2 52,3 53,6 55,0 54,3 56,

27 Trend of Individual Primary Performance Measures for AF Anticoagulant drug at discharge P < P < P = ACEI/ARB at discharge P = Beta blocker at discharge P = Statins at discharge P =0.108 * Trend Chi-square test 27

28 Downloading of The ly Quality Reports Phase 1 hospitals Phase 2 hospitals 41,5 58,5 Download Undownload 53,6 46,4 Download Undownload Phases No. of hospitals No. of reports Download rate () Phase Phase Total

29 Composite Scores of AF Primary Performance Measures Improved Significantly in Hospitals which Downloaded Reports ,04 P <0.001 P = ,96 55,44 53, ,41 42,81 43,3 44,03 42, * Trend Chi-square test 29

30 Hospital Awards of CCC Project Awards Medical Quality ACS-2016 AF-2016 No. No. Annual Awards Conference Gold Silver Bronze Progress Data Quality Active Participation Total No. of Hospitals

31 Summary The infrastructure for the CCC project has been successfully set up, and lays a foundation for long-term quality improvement activities across China; Preliminary analysis identified major problems in quality of care for ACS and AF inpatients and key points for quality improvement in tertiary hospitals of China; Timely feedback of the quality of care by monthly quality reports is helpful for hospitals to identify problems in performance and to improve the quality of care; During the 2 years of CCC project, many hospitals have made achievements. With the secondary hospitals joined, it will make CCC project get a promotion in a greater scope. With everyone s efforts, this project will contribute to the improvement in quality of care for cardiovascular disease in China. 31

32 AHA and CSC SMG members International Director Ms. Louise Morgan National Director Prof. Dong ZHAO CCC executive team Pfizer, Boehringer-Ingelheim, and H&J CRO International, Inc. All collaborating hospitals of CCC Project

33

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