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Table 5 Synthesis of quantitative and qualitative data to inform intervention factors, context, and underlying mechanisms influencing outcomes

From: Implementation and acceptability of a heart attack quality improvement intervention in India: a mixed methods analysis of the ACS QUIK trial

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
  1. aOutcome definition: observed (directly evident from the data), implied (no direct data available but interpreted based on triangulated results), or anticipated (based on assumptions guided by the interview or survey data)