Table 5 Synthesis of quantitative and qualitative data to inform intervention factors, context, and underlying mechanisms influencing outcomes
Intervention components | Level intervention is operating | Intervention factors | Contextual factors | Mechanistic factors | Outcome | Outcomea: observed, implied, or anticipated |
|---|---|---|---|---|---|---|
Audit and feedback report | Hospital/institution | Audit report summarized the key performance indicators of hospital in comparison to other hospitals in the cohort and all the hospitals participating in the ACS QUIK trial. | Formative work identified lack of systems to track quality of care indicators | We hypothesize that monthly review of audit report stimulates clinical team to set goals to make changes that will improve processes and clinical outcomes. | Clinical team used evidence provided in the audit report for 50–85% of their patients but quality improvement meetings were rare and changes in clinical practice based on these data were not identified. | Observed |
Admission and discharge checklists | Physician, nurse | Admission and discharge checklists incorporated evidence-based guideline recommended treatment for acute myocardial infraction care at admission and discharge. | To minimize variability in practice across hospitals and promote checklists to embed evidence in decision-making | Checklists enhance prescription of evidence-based treatment in-hospital and at discharge. | Overall improved prescription of aspirin, beta-blocker and statins at discharge. | Observed |
Patient education materials | Patient | Patient education materials were developed with a focus on tobacco cessation, diet, exercise and cardiac rehabilitation post-acute myocardial infarction. | Lack of tobacco cessation counseling, heart-healthy diet and exercise information for patients with acute myocardial infarction | Patient education sped-up recovery post-event and reduce the risk of recurrent event. | Education material may have enhanced patient self-care post-acute myocardial infarction. | Implied |
Guidelines to develop rapid response and code blue team | Hospital/institutional | Guidelines and relevant training were provided to the team to establish rapid response and code teams. | Absence of rapid response and code team in most settings | Development of rapid response and code team facilitated clinical team to do their work more efficiently and are therefore valued. | Evidence will be considered more systematically across departments when policy is developed and implemented. | Anticipated |