Factors Associated With Medical Staff's Engagement and Perception of a Quality Improvement Program for Acute Coronary Syndromes in Hospitals: A Nationally Representative Mixed-Methods Study in China.
Shuduo Zhou, Yinzi Jin, Junxiong Ma, Xuejie Dong, Na Li, Hong Shi, Yan Zhang, Xiaoyu Guan, Kenneth A LaBresh, Sidney C Smith, Yong Huo, Zhi-Jie Zheng
Author Information
Shuduo Zhou: Department of Global Health Peking University School of Public Health Beijing China.
Yinzi Jin: Department of Global Health Peking University School of Public Health Beijing China.
Junxiong Ma: Department of Global Health Peking University School of Public Health Beijing China.
Xuejie Dong: Department of Global Health Peking University School of Public Health Beijing China. ORCID
Na Li: Department of Global Health Peking University School of Public Health Beijing China.
Hong Shi: China Cardiovascular Association and China Chest Pain Centers Suzhou China.
Yan Zhang: Division of Cardiology Peking University First Hospital Beijing China. ORCID
Xiaoyu Guan: China Cardiovascular Association and China Chest Pain Centers Suzhou China.
Kenneth A LaBresh: RTI International Waltham MA.
Sidney C Smith: Division of Cardiovascular Medicine School of Medicine University of North Carolina at Chapel Hill NC. ORCID
Yong Huo: Division of Cardiology Peking University First Hospital Beijing China.
Zhi-Jie Zheng: Department of Global Health Peking University School of Public Health Beijing China. ORCID
Background Medical staff represent critical stakeholders in the process of implementing a quality improvement (QI) program. Few studies, however, have examined factors that influence medical staff engagement and perception regarding QI programs. Methods and Results We conducted a nationally representative survey of a QI program in 6 cities in China. Quantitative data were analyzed using multilevel mixed-effects linear regression models, and qualitative data were analyzed using the framework method. The engagement of medical staff was significantly related to knowledge scores regarding the specific content of chest pain center accreditation (β=0.42; 95% CI, 0.27-0.57). Higher scores for inner motivation (odds ratio [OR], 1.79; 95% CI, 1.18-2.72) and resource support (OR, 1.52; 95% CI, 1.02-2.24) and lower scores for implementation barriers (OR, 0.81; 95% CI, 0.67-0.98) were associated with improved treatment behaviors among medical staff. Resource support (OR, 4.52; 95% CI, 2.99-6.84) and lower complexity (OR, 0.81; 95% CI, 0.65-1.00) had positive effects on medical staff satisfaction, and respondents with improved treatment behaviors were more satisfied with the QI program. Similar findings were found for factors that influenced medical staff's assessment of QI program sustainability. The qualitative analysis further confirmed and supplemented the findings of quantitative analysis. Conclusions Clarifying and addressing factors associated with medical staff's engagement and perception of QI programs will allow further improvements in quality of care for patients with acute coronary syndrome. These findings may also be applicable to other QI programs in China and other low- and middle-income countries. Registration URL: https://www.chictr.org.cn/; Unique identifier: Chi-CTR2100043319.
