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Evaluation of medical quality and treatment trends of nonvalvular atrial fibrillation in Beijing inpatients

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机构: [1]Capital Med Univ, Beijing Anzhen Hosp, Natl Clin Res Ctr Cardiovasc Dis,Dept Cardiol, Beijing Adv Innovat Ctr Big Data Based Precis Med, 2 Anzhen Rd, Beijing 100029, Peoples R China [2]Capital Med Univ, Beijing Tongren Hosp, Cardiovasc Ctr, Beijing, Peoples R China
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关键词: Atrial fibrillation (AF) performance measure (PM) quality measure (QM) compliance

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Background: The quality of care presented to AF cases in tertiary and non- tertiary hospitals in China remains obscure and needs further investigation. Therefore, we examined the compliance with quality measures (QMs) and clinical performance measures (PMs) that were proposed by the ACC/AHA in 2016 in a Chinese adult population with nonvalvular atrial fibrillation (AF). We also investigated the changes in patients' characteristics, treatment plans, and quality of provided care at different time-points [2011-2016]. Methods: We used the datasets from two registry-based studies in Beijing, including the Chinese Atrial Fibrillation Registry (CHINA-AF) investigation. From August 2011 to July 2016, an overall number of 13,439 nonvalvular AF cases were included. Our primary outcome was to determine the compliance rate with two PMs [oral anticoagulant (OAC) use and prothrombin time international normalized ratio (INR)] and six QMs (beta-blocker, ACEI-ARB, and the inappropriate prescription of antiarrhythmic drugs, Sotalol, antiplatelet and OAC, and non-dihydropyridine calcium channel antagonist) over a period of 5 years [20112016]. Also, the difference in compliance between tertiary and non-tertiary hospitals was investigated. Results: The compliance with PMs and QMs was variable between tertiary and non-tertiary hospitals. In tertiary hospitals, the total number of inpatient beds was >500, and each bed was equipped with >1.03 health technical personnel and >0.4 nurses. In non-tertiary hospitals, the available beds capacity was <500, and each bed corresponded with 0.7-0.88 health technical personnel and >0.4 nurses. The compliance rates with OAC use steadily increased from 2011-2015 in tertiary hospitals (35%, 35.9%, 37.9%, 45%, and 49%, P<0.001). In non-tertiary hospitals, INR follow-up of warfarin use increased significantly over the years, with rates of 36.2%, 60.5%, 71.6%, 64.3%, and 81.5% (P=0.04), respectively. In terms of QMs, the compliance with the six measure sets was quite similar among tertiary and non-tertiary hospitals avoiding any significant difference over the years (P>0.05). Conclusions: We noted an improvement in medical quality regarding the use of OAC, especially in tertiary hospitals. Meanwhile, the compliance rates of INR follow-up improved in non-tertiary hospitals. However, the compliance rates of other performance and QMs are still low, which are in need of improvement.

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大类 | 2 区 医学
小类 | 2 区 卫生保健与服务
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Q3 HEALTH CARE SCIENCES & SERVICES
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第一作者机构: [1]Capital Med Univ, Beijing Anzhen Hosp, Natl Clin Res Ctr Cardiovasc Dis,Dept Cardiol, Beijing Adv Innovat Ctr Big Data Based Precis Med, 2 Anzhen Rd, Beijing 100029, Peoples R China [2]Capital Med Univ, Beijing Tongren Hosp, Cardiovasc Ctr, Beijing, Peoples R China
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通讯机构: [1]Capital Med Univ, Beijing Anzhen Hosp, Natl Clin Res Ctr Cardiovasc Dis,Dept Cardiol, Beijing Adv Innovat Ctr Big Data Based Precis Med, 2 Anzhen Rd, Beijing 100029, Peoples R China [*1]Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing Advanced Innovation Center for Big Data-Based Precision Medicine for Cardiovascular Diseases, No. 2, Anzhen Rd, Chaoyang District, Beijing 100029, China
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