Acute Coronary Syndrome KCMC

Study Overview
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Brief Summary
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The purpose of this study is to develop a quality improvement intervention to address barriers to evidence-based acute coronary syndrome (ACS) care in northern Tanzania. Patients who presented to Kilimanjaro Christian Medical Center (KCMC) will be asked to complete a survey about barriers and facilitators of health care. In addition the survey will be administered to all providers, policymakers, and administrators participating in in-depth interviews. Data from this survey will be used to develop a quality improvement intervention that will be piloted by KCMC staff. Six months after the pilot program is implemented providers, patients, and administrators will be interviewed for their perspectives on the program.

Official Title
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Community and Physician Perceptions of Chest Pain and Prevalence of Acute Coronary Syndrome Among HIV-infected and -Uninfected Patients in Moshi, Tanzania

Conditions
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Acute Coronary Syndrome

Intervention / Treatment
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* Other: Quality Improvement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years or older symptoms related to acute coronary syndrome myocardial infarction clinically sober able to communicate in Swahili or English Exclusion Criteria: medically unstable have a deteriorating condiction too critically ill to participate

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: MI Patients in northern Tanzania<br>Patients presenting to KCMC emergency department with acute MI | Other: Quality Improvement<br>* A quality improvement intervention including reminders, care protocols, and text messages to improve care of myocardial infarction in the KCMC ED<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability as measured by the Acceptability of Intervention Measure (AIM) | The AIM tool is a 4-question survey that evaluates the acceptability of an intervention. Responses to each question are on a 5-point Likert Scale (Strongly Agree=5, Agree=4, Neutral=3, Disagree=2, Strongly Disagree=1). Responses of Strongly Agree (5) and Agree (4) are considered to indicate a more acceptable intervention. The responses to each question will be averaged together to give an acceptability score between 1 and 5 for each respondent. The primary outcome will be the overall mean acceptability score among respondents. A mean acceptability score >= 4 will be considered to indicate acceptability. | Initial ED visit (baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patients presenting with chest pain or shortness of breath who undergo ECG and cardiac biomarker testing during their ED stay | Percentage of patients with these symptoms who undergo ECG and cardiac biomarker testing | Initial ED visit (baseline) | 
| Patients with ACS taking aspirin 30 days after enrollment | Percentage of patients taking aspiring at 30 days | 30 days after enrollment | 
| Survival of ACS patients at 30 days after enrollment | Percentage of patients who have survived at 30 days | 30 days after enrollment | 
| Aspirin administration | Percent of ED patients diagnosed with acute coronary syndrome receiving aspirin. | Initial ED visit (baseline) |