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首頁> 外文期刊>The American heart journal >A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: Rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial
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A multifaceted intervention to narrow the evidence-based gap in the treatment of acute coronary syndromes: Rationale and design of the Brazilian Intervention to Increase Evidence Usage in Acute Coronary Syndromes (BRIDGE-ACS) cluster-randomized trial

機譯：縮小急性冠狀動脈綜合征治療中基于證據(jù)的差距的多方面干預措施：巴西干預以提高急性冠狀動脈綜合征的證據(jù)使用率的理論基礎(chǔ)和設(shè)計（BRIDGE-ACS）整群隨機試驗

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Translating evidence into clinical practice in the management of acute coronary syndromes (ACS) is challenging. Few ACS quality improvement interventions have been rigorously evaluated to determine their impact on patient care and clinical outcomes. We designed a pragmatic, 2-arm, cluster-randomized trial involving 34 clusters (Brazilian public hospitals). Clusters were randomized to receive a multifaceted quality improvement intervention (experimental group) or routine practice (control group). The 6-month educational intervention included reminders, care algorithms, a case manager, and distribution of educational materials to health care providers. The primary end point was a composite of evidence-based post-ACS therapies within 24 hours of admission, with the secondary measure of major cardiovascular clinical events (death, nonfatal myocardial infarction, nonfatal cardiac arrest, and nonfatal stroke). Prescription of evidence-based therapies at hospital discharge were also evaluated as part of the secondary outcomes. All analyses were performed by the intention-to-treat principle and took the cluster design into account using individual-level regression modeling (generalized estimating equations). If proven effective, this multifaceted intervention would have wide use as a means of promoting optimal use of evidence-based interventions for the management of ACS.
機譯：將證據(jù)轉(zhuǎn)化為急性冠脈綜合征（ACS）管理的臨床實踐具有挑戰(zhàn)性。很少對ACS質(zhì)量改善干預措施進行嚴格評估，以確定其對患者護理和臨床結(jié)果的影響。我們設(shè)計了一個實用的2臂集群隨機試驗，涉及34個集群（巴西公立醫(yī)院）。將各組隨機接受多方面的質(zhì)量改善干預措施（實驗組）或常規(guī)做法（對照組）。為期6個月的教育干預包括提醒，護理算法，案例管理員，以及向醫(yī)療服務提供者分發(fā)教育材料。主要終點是入院后24小時內(nèi)循證ACS后治療的綜合結(jié)果，其次是主要心血管臨床事件（死亡，非致命性心肌梗塞，非致命性心臟驟停和非致命性中風）的次要指標。作為次要結(jié)果的一部分，還評估了出院時循證療法的處方。所有分析均按意向性處理原則進行，并使用個體水平回歸模型（廣義估計方程）考慮了聚類設(shè)計。如果證明有效，這種多方面的干預措施將被廣泛用作促進對循證醫(yī)學干預措施進行最佳管理的手段。

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