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Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing

BACKGROUND: Quality of care (QoC) attracts global concerns when unsafe and misuse of healthcare wastes resources and endangers people’s health, especially in low- and middle-income countries. However, little is known about quality of care delivered in China. This study was intended to gauge the qual...

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Autores principales: Zhou, Yuqi, Yao, Xi, Liu, Guofeng, Jian, Weiyan, Yip, Winnie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339278/
https://www.ncbi.nlm.nih.gov/pubmed/30658628
http://dx.doi.org/10.1186/s12913-019-3872-0
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author Zhou, Yuqi
Yao, Xi
Liu, Guofeng
Jian, Weiyan
Yip, Winnie
author_facet Zhou, Yuqi
Yao, Xi
Liu, Guofeng
Jian, Weiyan
Yip, Winnie
author_sort Zhou, Yuqi
collection PubMed
description BACKGROUND: Quality of care (QoC) attracts global concerns when unsafe and misuse of healthcare wastes resources and endangers people’s health, especially in low- and middle-income countries. However, little is known about quality of care delivered in China. This study was intended to gauge the quality of care for acute myocardial infarction (AMI) patients in Beijing and identify the quality gaps across tertiary hospitals. METHODS: One thousand two hundred twenty eight patients, covered by Employee Essential Health Insurance Scheme and diagnosed of AMI, was sampled from 14 large comprehensive hospitals in Beijing, China. Chart review study was conducted through the discharge data and medical records of inpatients to evaluate 6 quality outcomes of interest, including the use of aspirin, beta blocker, and statin at discharge; use of aspirin within 24 h at arrival; angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD); percutaneous transluminal coronary intervention (PCI) within 90 min at arrival. RESULTS: Of the 1228 subjects, the mean age was 60.8 (11.8 SD) years and 83.0% were male. The overall medication prescribed was highly compliant with the clinical guidelines (97.0% [95% CI 96.8–97.2] for aspirin and 96.3% [95% CI 96.0–96.5] for statin), except for beta-blocker (83.6% [95% CI 83.0–84.1]) and ACEI/ARB use (61.4% [95% CI 60.7–62.2]). More than half of eligible patients did not receive appropriate PCI therapy (44.0% [95% CI 42.5–45.4]). Great variations across hospitals was observed in aspirin within 24 h and beta-blocker at discharge (P < 0.001), and the risk-adjusted results remained robust. CONCLUSION: Underuse of recommended treatment and significant variations of quality were found for AMI patients across tertiary hospitals in Beijing. It raised great concerns on poorer quality of care in other less-developed areas with less medical resources. Practical actions are needed in reducing quality gaps to ensure the delivery of quality care.
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spelling pubmed-63392782019-01-23 Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing Zhou, Yuqi Yao, Xi Liu, Guofeng Jian, Weiyan Yip, Winnie BMC Health Serv Res Research Article BACKGROUND: Quality of care (QoC) attracts global concerns when unsafe and misuse of healthcare wastes resources and endangers people’s health, especially in low- and middle-income countries. However, little is known about quality of care delivered in China. This study was intended to gauge the quality of care for acute myocardial infarction (AMI) patients in Beijing and identify the quality gaps across tertiary hospitals. METHODS: One thousand two hundred twenty eight patients, covered by Employee Essential Health Insurance Scheme and diagnosed of AMI, was sampled from 14 large comprehensive hospitals in Beijing, China. Chart review study was conducted through the discharge data and medical records of inpatients to evaluate 6 quality outcomes of interest, including the use of aspirin, beta blocker, and statin at discharge; use of aspirin within 24 h at arrival; angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD); percutaneous transluminal coronary intervention (PCI) within 90 min at arrival. RESULTS: Of the 1228 subjects, the mean age was 60.8 (11.8 SD) years and 83.0% were male. The overall medication prescribed was highly compliant with the clinical guidelines (97.0% [95% CI 96.8–97.2] for aspirin and 96.3% [95% CI 96.0–96.5] for statin), except for beta-blocker (83.6% [95% CI 83.0–84.1]) and ACEI/ARB use (61.4% [95% CI 60.7–62.2]). More than half of eligible patients did not receive appropriate PCI therapy (44.0% [95% CI 42.5–45.4]). Great variations across hospitals was observed in aspirin within 24 h and beta-blocker at discharge (P < 0.001), and the risk-adjusted results remained robust. CONCLUSION: Underuse of recommended treatment and significant variations of quality were found for AMI patients across tertiary hospitals in Beijing. It raised great concerns on poorer quality of care in other less-developed areas with less medical resources. Practical actions are needed in reducing quality gaps to ensure the delivery of quality care. BioMed Central 2019-01-18 /pmc/articles/PMC6339278/ /pubmed/30658628 http://dx.doi.org/10.1186/s12913-019-3872-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zhou, Yuqi
Yao, Xi
Liu, Guofeng
Jian, Weiyan
Yip, Winnie
Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title_full Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title_fullStr Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title_full_unstemmed Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title_short Level and variation on quality of care in China: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in Beijing
title_sort level and variation on quality of care in china: a cross-sectional study for the acute myocardial infarction patients in tertiary hospitals in beijing
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339278/
https://www.ncbi.nlm.nih.gov/pubmed/30658628
http://dx.doi.org/10.1186/s12913-019-3872-0
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