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Table 1 Optimized and current QI initiatives in the CHANGE program

From: A stepped wedge cluster randomized control trial to evaluate the implementation and effectiveness of optimized initiatives in improving quality of care for ST segment elevation myocardial infarction in response to the COVID-19 outbreak

QI initiatives Details Classification
(1) Accreditation of hospital-based CPCs ▪ The comprehensive center criteria are applicable to the comprehensive CPCs at tertiary hospitals; while the basic center criteria targets the basic CPCs at secondary hospitals.
▪ Both editions of the criteria include 5 dimensions of qualification: conditions of facilities, diagnosis and treatment process, integration of prehospital and hospital care, training and education, and real-time data reporting.
▪ Registered hospitals need to go through 3 stages including self-assessment, accreditation, and re-accreditation every 3 years, to develop an accredited CPC.
▪ The accreditation process is jointly led by the China CPC Headquarters, Regional Accreditation Offices, and Provincial-level CPC Alliances.
Current and optimized
(2) Quality monitor and assessment ▪ Accredited hospitals should continuously report data for monitoring and feedback.
▪ The indicators for measuring the CPC performance in the quarterly and annually benchmarked reports are developed by the China CPC Headquarters, based on the ACC/AHA Performance Measures and clinical practice guidelines.
▪ There are two sets of performance measures respectively for comprehensive and basic CPCs.
▪ Ranking of a CPC is calculated based on the percentile of each indicator and a weighted composite score. The score of 100, 80, 60, 40, 20, and 0 are for ranking the top 10%, 10–30%, 30–50%, 50–70%, 70–90%, and 90–100% of the measure among the entire accredited CPCs.
Current and optimized
(3) Quality review and feedback ▪ Improvement in adherence to the guideline recommendations is facilitated through monthly and quarterly hospital-specific performance feedback reports.
▪ The hospital-specific data are compared against a variety of internal and external benchmarks, including the temporal trend in performance and comparison points to regional or national performance thresholds.
▪ A series of regular meeting, QI analysis meeting, and case study meeting are carried out at least once every quarter for sharing of ‘best practice’ clinical support tools.
Current and optimized
(4) Dedicated regional coordinator ▪ Dedicated regional coordinator charged with implementing systematic improvements within every hospital and EMS agency will be assigned by city-level CPC Alliances.
▪ Dedicated regional coordinators will work with the local health bureau to promote the optimized QI initiatives.
▪ The work of dedicated regional coordinators will include synthesizing emergency infection protocols to contain COVID-19 with QI initiatives, coordinating care between community, hospitals, and EMS agency, maintaining the safety of healthcare workers, minimizing contamination of laboratory facilities.
▪ The work of dedicated regional coordinators will be supervised by the city-level CPC Alliances and the China CPC Headquarters.
Optimized
(5) Education and training activities ▪ The training on emergency infection protocols instituted in hospitals to contain COVID-19 targeting at healthcare professionals will be conducted by hospitals
▪ Education on STEMI awareness and COVID-19 knowledge targeting community residents will be conducted by community health centers, which are trained and supervised by hospitals within the medical consortium.
Optimized
  1. QI Quality improvement; CHANGE National Chest Pain Center Accreditation Program; CPC Chest pain center; EMS Emergency medical services; ACC/AHA American College of Cardiology/American Heart Association; COVID-19 Coronavirus disease 2019; STEMI ST segment elevation myocardial infarction