Skip to main content
  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

  • Home
  • About this Journal
    • Editorial Board
    • General Statistics
    • Information for Advertisers
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
    • Assistant Reviewer Program
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • AHA Guidelines and Statements
    • Special Issues
    • Patient and Caregiver Viewpoints
    • Care Innovations
    • Circ CQO Twitter Journal Club
    • Data Visualizations
  • Resources
    • Instructions for Authors
      • Accepted Manuscripts
    • → Article Types
    • → General Preparation Instructions
    • → Revised Manuscripts
    • → Research Guidelines
    • → How to Submit a Manuscript
    • Journal Policies
    • Permissions and Rights Q&A
    • Submission Sites
    • AHA Journals RSS Feeds
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
  • Twitter

  • My alerts
  • Sign In
  • Join

  • Advanced search

Header Publisher Menu

  • American Heart Association
  • Science Volunteer
  • Warning Signs
  • Advanced Search
  • Donate

Circulation:
Cardiovascular Quality and Outcomes

  • My alerts
  • Sign In
  • Join

  • Twitter
  • Home
  • About this Journal
    • Editorial Board
    • General Statistics
    • Information for Advertisers
    • Author Reprints
    • Commercial Reprints
    • Customer Service and Ordering Information
    • Assistant Reviewer Program
  • All Issues
  • Subjects
    • All Subjects
    • Arrhythmia and Electrophysiology
    • Basic, Translational, and Clinical Research
    • Critical Care and Resuscitation
    • Epidemiology, Lifestyle, and Prevention
    • Genetics
    • Heart Failure and Cardiac Disease
    • Hypertension
    • Imaging and Diagnostic Testing
    • Intervention, Surgery, Transplantation
    • Quality and Outcomes
    • Stroke
    • Vascular Disease
  • Browse Features
    • AHA Guidelines and Statements
    • Special Issues
    • Patient and Caregiver Viewpoints
    • Care Innovations
    • Circ CQO Twitter Journal Club
    • Data Visualizations
  • Resources
    • Instructions for Authors
    • → Article Types
    • → General Preparation Instructions
    • → Revised Manuscripts
    • → Research Guidelines
    • → How to Submit a Manuscript
    • Journal Policies
    • Permissions and Rights Q&A
    • Submission Sites
    • AHA Journals RSS Feeds
    • International Users
    • AHA Newsroom
  • AHA Journals
    • AHA Journals Home
    • Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB)
    • Circulation
    • → Circ: Arrhythmia and Electrophysiology
    • → Circ: Genomic and Precision Medicine
    • → Circ: Cardiovascular Imaging
    • → Circ: Cardiovascular Interventions
    • → Circ: Cardiovascular Quality & Outcomes
    • → Circ: Heart Failure
    • Circulation Research
    • Hypertension
    • Stroke
    • Journal of the American Heart Association
Original Article

System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China

Qualitative Analysis

Isuru Ranasinghe, Ye Rong, Xin Du, Yangfang Wang, Runlin Gao, Anushka Patel, Yangfeng Wu, Rick Iedema, Zhixin Hao, Dayi Hu, Fiona Turnbull
Download PDF
https://doi.org/10.1161/CIRCOUTCOMES.113.000527
Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000527
Originally published March 11, 2014
Isuru Ranasinghe
From the Cardiovascular Division, George Institute for Global Health, University of Sydney, Sydney, Australia (I.R., Y.R., A.P., F.T.); George Institute for Global Health at Peking University Health Science Center, Beijing, China (X.D., Y. Wu, Z.H.); Beijing Anzhen Hospital, Capital Medical University, Beijing, China (X.D.); Clinical Research Institute, Peking University Health Science Center, Beijing, China (Y. Wang, Y. Wu); Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (R.G.); Agency for Clinical Innovation, NSW Ministry of Health, Sydney, Australia (R.I.); and Department of Cardiology, Peking University People’s Hospital, Beijing, China (D.H.).
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ye Rong
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Xin Du
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yangfang Wang
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Runlin Gao
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anushka Patel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Yangfeng Wu
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rick Iedema
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Zhixin Hao
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Dayi Hu
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Fiona Turnbull
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Supplemental Materials
  • Info & Metrics
  • eLetters

Jump to

  • Article
  • Supplemental Materials
  • Info & Metrics
  • eLetters
Loading

Abstract

Background—Organizational and wider health system factors influence the implementation and success of interventions. Clinical Pathways in Acute Coronary Syndromes 2 is a cluster randomized trial of a clinical pathway–based intervention to improve acute coronary syndrome care in hospitals in China. We performed a qualitative evaluation to examine the system-level barriers to implementing clinical pathways in the dynamic healthcare environment of China.

Methods and Results—A qualitative descriptive analysis of 40 in-depth interviews with health professionals conducted in a sample of 10 hospitals purposively selected to explore barriers to implementation of the intervention. Qualitative data were analyzed using the Framework method. In-depth interviews identified 5 key system-level barriers to effective implementation: (1) leadership support for implementing quality improvement, (2) variation in the capacity of clinical services and quality improvement resources, (3) fears of patient disputes and litigation, (4) healthcare funding constraints and high out-of-pocket expenses, and (5) patient-related factors.

Conclusions—System-level barriers affect the ability of acute coronary syndrome clinical pathways to change practice. Addressing these barriers in the context of current and planned national health system reform will be critical for future improvements in the management of acute coronary syndromes, and potentially other hospitalized conditions, in China.

Clinical Trial Registration—URL: http://www.anzctr.org.au/default.aspx. Register. Unique identifier: ACTRN12609000491268.

  • acute coronary syndrome
  • quality of health care
  • Received August 19, 2013.
  • Accepted December 17, 2013.
  • © 2014 American Heart Association, Inc.
Back to top

Current Issue

Circulation: Cardiovascular Quality and Outcomes
April 2018, Volume 11, Issue 4
  • Table of Contents

Jump to

  • Article
  • Supplemental Materials
  • Info & Metrics
  • eLetters

Article Tools

  • Print
  • Citation Tools
    System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China
    Isuru Ranasinghe, Ye Rong, Xin Du, Yangfang Wang, Runlin Gao, Anushka Patel, Yangfeng Wu, Rick Iedema, Zhixin Hao, Dayi Hu and Fiona Turnbull
    Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000527, originally published March 11, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000527

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
  • Article Alerts
    Log in to Email Alerts with your email address.
  • Save to my folders

Share this Article

  • Email

    Thank you for your interest in spreading the word on Circulation: Cardiovascular Quality and Outcomes.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China
    (Your Name) has sent you a message from Circulation: Cardiovascular Quality and Outcomes
    (Your Name) thought you would like to see the Circulation: Cardiovascular Quality and Outcomes web site.
  • Share on Social Media
    System Barriers to the Evidence-Based Care of Acute Coronary Syndrome Patients in China
    Isuru Ranasinghe, Ye Rong, Xin Du, Yangfang Wang, Runlin Gao, Anushka Patel, Yangfeng Wu, Rick Iedema, Zhixin Hao, Dayi Hu and Fiona Turnbull
    Circulation: Cardiovascular Quality and Outcomes. 2014;CIRCOUTCOMES.113.000527, originally published March 11, 2014
    https://doi.org/10.1161/CIRCOUTCOMES.113.000527
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo

Related Articles

Cited By...

Subjects

  • Quality and Outcomes
    • Ethics and Policy
  • Vascular Disease
    • Acute Coronary Syndromes

Circulation: Cardiovascular Quality and Outcomes

  • About Circulation: Cardiovascular Quality and Outcomes
  • Instructions for Authors
  • AHA CME
  • Guidelines and Statements
  • Meeting Abstracts
  • Permissions
  • Journal Policies
  • Email Alerts
  • Open Access Information
  • AHA Journals RSS
  • AHA Newsroom

Editorial Office Address:
200 Fifth Avenue, Suite 1020
Waltham, MA 02451 
Email: circ@circulationjournal.org

Information for:
  • Advertisers
  • Subscribers
  • Subscriber Help
  • Institutions / Librarians
  • Institutional Subscriptions FAQ
  • International Users
American Heart Association Learn and Live
National Center
7272 Greenville Ave.
Dallas, TX 75231

Customer Service

  • 1-800-AHA-USA-1
  • 1-800-242-8721
  • Local Info
  • Contact Us

About Us

Our mission is to build healthier lives, free of cardiovascular diseases and stroke. That single purpose drives all we do. The need for our work is beyond question. Find Out More about the American Heart Association

  • Careers
  • SHOP
  • Latest Heart and Stroke News
  • AHA/ASA Media Newsroom

Our Sites

  • American Heart Association
  • American Stroke Association
  • For Professionals
  • More Sites

Take Action

  • Advocate
  • Donate
  • Planned Giving
  • Volunteer
  • You're the Cure

Online Communities

  • AFib Support
  • Empowered to Serve
  • Garden Community
  • Patient Support Network
  • Professional Online Network

Follow Us:

  • Follow Circulation on Twitter
  • Visit Circulation on Facebook
  • Follow Circulation on Google Plus
  • Follow Circulation on Instagram
  • Follow Circulation on Pinterest
  • Follow Circulation on YouTube
  • Rss Feeds
  • Privacy Policy
  • Copyright
  • Ethics Policy
  • Conflict of Interest Policy
  • Linking Policy
  • Diversity
  • Careers

©2018 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited. The American Heart Association is a qualified 501(c)(3) tax-exempt organization.
*Red Dress™ DHHS, Go Red™ AHA; National Wear Red Day ® is a registered trademark.

  • PUTTING PATIENTS FIRST National Health Council Standards of Excellence Certification Program
  • BBB Accredited Charity
  • Comodo Secured