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Tailoring implementation strategies for acute coronary syndrome quality improvement program at primary care level in

Can Liu1,2, Yixuan Wu1, Zongbin Wang1

  • 1Department of Clinical Epidemiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China.

Health Policy and Planning
|May 8, 2026
PubMed

Insights

Implementing the Chest Pain Unit (CPU) program in China faces barriers like technical issues and low awareness. Strategies include enhancing capacity, funding, and community engagement for better acute coronary syndrome (ACS) care.

Area of Science:

  • Cardiology
  • Public Health
  • Health Services Research

Background:

  • Acute coronary syndrome (ACS), particularly ST-segment elevation myocardial infarction (STEMI), represents a significant public health challenge in China.
  • The Chest Pain Unit (CPU) program aims to improve early identification and treatment of STEMI by optimizing referral pathways.

Purpose of the Study:

  • To explore barriers and facilitators to implementing the CPU program in China.
  • To propose context-specific strategies for optimizing CPU delivery and scalability.

Main Methods:

  • A qualitative study utilizing semi-structured interviews with 61 key informants from 36 township hospitals across eastern, central, and western China.
  • Thematic coding guided by the Consolidated Framework for Implementation Research (CFIR) 2.0.
  • Implementation strategies refined using Expert Recommendations for Implementing Change.

Main Results:

  • Identified 46 barriers and 50 facilitators across all 5 CFIR domains.
  • Key barriers include technical deficiencies, low health-seeking awareness, financial constraints, ineffective awareness campaigns, and limited professional knowledge.
  • A three-pronged strategy framework (innovation optimization, external empowerment, internal improvement) was developed.

Conclusions:

  • Urgent strategies include enhancing technical capacity, expanding financing, community empowerment, mass media campaigns, structured patient follow-up, and continuous training.
  • The proposed strategies can facilitate timely ACS detection and intervention in primary healthcare settings.

Keywords:
CFIRChinaERICbarrierschest pain unitfacilitatorsqualitative study

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