Research design

An Interupted Time Series design on improvement of quality of care for patients with STEMI in a hospital context

CP4ACS uses an interrupted time series design measuring quality of STEMI care and the context of STEMI care provided in hospitals. The study combines one retrospective (time 1) and two prospective measurements (time 2 and time 3). CP4ACS is a national multicentre research project in 15 hospitals with a cardiology department. Participating hospitals are Belgian members of the Belgian Dutch Care Pathway Network, a knowledge sharing social capital network of health care organizations in Belgium on care pathways, coordinated by KU Leuven.

Quality of care will be measured at time 1, 2 and 3. Variables on quality of care will consist of key interventions and quality indicators selected through systematic review and validated by a RAND modified Delphi method. The context of STEMI care provided in hospitals is measured at micro-, meso- and macrosystem level.

This study entails two sequential interventions. The first intervention is a standardized complex intervention as used in previous doctoral research projects. Between time 1 and time 2, this first intervention provides all participating hospitals with (1) feedback on the quality of care including anonymously benchmarking with the group results of the participating hospitals; (2) a model STEMI care pathway defining the evidence based key interventions and quality indicators and their respective targets; and (3) a care pathway registration document for local implementation. The second intervention is planned between time 2 and time 3. This boosted care pathway intervention repeats all three elements of intervention 1 but adds quality improvement support to catalyze improvement. The quality improvement support is based on the collaborative methodology as described by the Institute for Healthcare Improvement. Specific attention to STEMI process improvement will be on reperfusion delays (i.e. door to balloon time), discharge medication and life style changes (i.e. smoking cessation, nutritional advice and activity level).