ABC | Volume 115, Nº1, July 2020

95 Original Article Taniguchi et al. Best practice in cardiology (BPC) program Arq Bras Cardiol. 2020; 115(1):92-99 and persuasion; coercion; and training). These groups of interventions will be implemented in all participating institutions and can be emphasized individually throughout the study according to the barriers identified at baseline and to the monthly reports on overall and specific adherence to recommendations. The description of the interventions embedded in each of these groups is available in Figure 1. Coordination of these activities will be made by a nurse, member of the Management Group, and will include checklists and reminders, webinars, automatic and real time reports through an electronic database, educational materials, quarterly meetings for audit and feedback, and hospitals’ recognition and training on QI methodologies for the implementation of rapid improvement cycles by the use of the Institute for Healthcare Improvement (IHI) ’s tools. 25,26 Concepts of improvement such as training of a QI team and establishment of goals based on the barriers that need to be overcame and monitoring and analysis of results will be used throughout the study. The electronic reports will capture real time information when completed in the study’s electronic database. The reports will include specific run charts describing the temporal trends on a monthly basis of the overall and specific adherence rates of the institution in relation to an established goal of 85% and to the median rates observed in the selected period for that same institution. 27 Each institution will be able to see, in real time, their own run charts and the charts showing average rates of the other participating (anonymous) institutions. The coordinating center will be able to follow all the participating institutions concomitantly. For the purposes of this project, we established as a goal a threshold of 85% based on previously reported GWTG results, where clinical outcomes improved when institutions reached this threshold. 28 Hospitals will be recognized by SBC with a bronze award if they reach this threshold for at least three consecutive months, with a silver award if they sustain these results for at least six months and with a gold award if they continue on the threshold or above it for 12 consecutive months. Data analysis Data will be analyzed using R program version 3.4.0 or higher. Hospitals will be excluded from the analysis of a performance measure if less than 10 patients are noted in the denominator for that measure. Continuous variables with normal distribution will be summarized as mean and standard deviation, and those with skewed distribution as median and 25 th and 75 th percentiles. Ordinal or categorical variables will be reported as absolute frequencies, percentages and 95% confidence intervals. Missing data will be addressed on an analysis-specific basis and considered non-compliance for the specific measure. Figure 1 – Intervention axes *Target of behavior change: health professionals &Target of behavior change: Patients and health professionals # Target of behavior change: Health managers. Sharing of sucessful experiences among the participating institutions related to performance improvement by web presentations and workshops