Trends in the Quality of Care for Acute Chest Pain after Chest Pain Center Accreditation

Abstract Background:Chest pain centers (CPCs) have become important for improving the quality of care for acute chest pain. However, no study has shown whether adherence to guidelines continuously improvesin CPCs after certification. Objectives:We aimed to analyze trends in quality indicator (QI) compliance rates of Chinese CPCs between January 1, 2016 and December 31, 2018. Methods: We drew a time series stacked area plot of compliance rates forQIs to describe the change in their cumulative value over time. Next, we selected the time points with the most remarkable change in the stacked area plot as the breakpoints and constructed an interrupted time series (ITS) design for analysis. Significant ITS results indicated that the breakpoints had effects on the trend. We then estimated the average monthly percent change (AMPC) using joinpoint regression analysis. Results: We found an unexpected downward trend in the cumulative compliance rates for the nine QIs assessed between the 12thand 13th months and between the 24thand 25th months. The trends of QI1‒5 showed a continuously increasing change. QI6‒8 showed an increasing trend in the middle and late periods of the study; QI9 showed an increasing trend in the early period. Conclusions:This study demonstrated a trend toward continued improvement in quality of care in CPCs after certification. Accreditation should focus on the coordination and management of cross-cutting clinical issues, while not neglecting the accuracy of timely diagnosis.