Quality Improvement Intervention on Utilization of Arterial Grafts for Coronary Artery Bypass Grafting
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- Enrollment
- 8,700
- Primary Endpoint
- Hospitals with low usage rates of internal mammary artery: internal mammary artery graft utilization rate
Study Overview
Brief Summary
This is a healthcare quality improvement study focused on increasing the utilization of arterial grafts in isolated coronary artery bypass grafting (CABG). Evidence indicates that arterial grafts, compared with venous grafts, provide superior long-term patency, which are recommended to use by the clinical practice guidelines.
In hospitals where the use of the internal mammary artery as a graft is relatively low(<90%) among CABG patients, multiple interventions will be implemented to improve its adoption rate.
In hospitals where internal mammary artery graft utilization is already high(≥90%), various interventions will be introduced to promote the use of multiple arterial grafts (defined as the use of two or more arterial conduits).
The study targets healthcare professionals as the primary subjects of intervention, with no direct interventions applied to patients during the study period. Changes in the internal mammary artery graft utilization rate and the multiple arterial graft utilization rate before and after the intervention will serve as the primary endpoints for evaluating intervention effectiveness in the two types of hospitals, respectively.
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patients whose data used to monitor the quality
- •Inclusion Criteria:
- •Aged ≥ 18 years old； Indicated for CABG and undergoing CABG.
Exclusion Criteria
- •History of prior CABG; Concurrent other cardiac surgeries on the day of CABG; Malignant tumor or life expectancy < 1 year;
- •50% stenosis of left subclavian artery; Pregnant women; Individuals diagnosed with mental illness or cognitive impairment (International Classification of Diseases-10 codes F01-F99); Patients considered by the investigator to have other factors unsuitable for inclusion.
Arms & Interventions
Improving the utilization rate of arterial grafts for coronary artery bypass grafting
In this stepped-wedge cluster randomized trial (SW-CRT) with a self-controlled design, hospitals were categorized into two groups according to their internal mammary artery graft usage rates, thereby forming two SW-CRT. Healthcare professionals at these hospitals will receive tailored interventions. The effectiveness of each intervention is assessed by comparing the usage rates before and after implementation within each SW-CRT.
Intervention: Interventions for healthcare professionals in hospitals with low usage rates (Behavioral)
Improving the utilization rate of arterial grafts for coronary artery bypass grafting
In this stepped-wedge cluster randomized trial (SW-CRT) with a self-controlled design, hospitals were categorized into two groups according to their internal mammary artery graft usage rates, thereby forming two SW-CRT. Healthcare professionals at these hospitals will receive tailored interventions. The effectiveness of each intervention is assessed by comparing the usage rates before and after implementation within each SW-CRT.
Intervention: Interventions for healthcare professionals in hospitals with high usage rates (Behavioral)
Outcomes
Primary Outcomes
Hospitals with low usage rates of internal mammary artery: internal mammary artery graft utilization rate
Time Frame: Duration of hospital stay(from date of admission to date of discharge)
Internal mammary artery graft utilization rate: the utilization rate of at least one internal mammary artery graft in patients received isolated coronary artery bypass grafting.
Hospitals with high usage rates of internal mammary artery: multiple arterial graft utilization rate
Time Frame: Duration of hospital stay(from date of admission to date of discharge)
Multiple arterial graft utilization rate: the utilization rate of two or more arterial conduits in patients received isolated coronary artery bypass grafting.
Secondary Outcomes
- In-hospital all-cause mortality rate(Duration of hospital stay(from date of admission to date of discharge))