Advances in Stroke: Quality Improvement

Bravata, Dawn M.; Purvis, Tara; Kilkenny, Monique F

doi:10.1161/strokeaha.122.037450

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…46 Unfortunately, similar population-level efforts or quality improvement initiatives to improve ambulatory secondary stroke preventive care are lacking, yet urgently needed to reduce the burden of recurrent stroke. 47 Our study is not without limitations. Our data are unable to speak of the coordination of health services, which could be the missing link that explains the observed differences in recurrent stroke risks in some immigrants and long-term residents.…”

Section: Discussionmentioning

confidence: 84%

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Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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Background and ObjectivesSecondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. MethodsWe conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. ResultsWe included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (−4.79%; −7.86 to −1.72) or have visits to a specialist (−1.68%; −3.12 to −0.24). There was minimal variation by region of origin or time since immigration in immigrants. DiscussionCompared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors. H0 Null Hypothesis A collection of negative, inconclusive, or replication studies; in partnership with the Center for Biomedical Research Transparency NPub.org/Null

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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“…32 The focus in recent years emphasizes collaboration among stakeholders to work together to utilize a framework for QI methodology to improve stroke performance measures, stroke survival, and outcomes for all patients. 16,33 In the United States, efforts to improve quality-driven stroke care are supported by the federal government through the mandated Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program. The Centers for Medicare and Medicaid Services participating hospitals may choose to report on selected stroke electronic clinical quality measures and are required to report on 30-day allcause ischemic stroke mortality.…”

mentioning

confidence: 99%

Improving Stroke Measure Compliance and Outcomes Through Hospital Collaboration

Moore

Summers

Wilson

2023

Stroke

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Globally, national stroke registries have been shown to improve the quality of patient care and outcomes. However, registry utilization and implementation vary by country. In the United States, stroke-specific performance measures must be met to achieve and maintain stroke center certification awarded by the state or nationally accredited certifying bodies. The 2 stroke registries available in the United States are the American Heart Association Get With The Guidelines-Stroke registry, which is voluntary, and the Paul Coverdell National Acute Stroke Registry, funded competitively to states by the Centers for Disease Control and Prevention. Compliance with stroke processes of care is variable, and quality improvement initiatives among organizations have been shown to have an impact on improving stroke care delivery. However, the effectiveness of interorganizational continuous quality improvement approaches, especially among competing institutions, to improving stroke care is ambiguous, and no uniform governance for successful interhospital collaboration has been identified. The purpose of this article is to review national initiatives focused on interorganizational collaboration to improve stroke care delivery with a focus on interhospital collaboration in the United States to improve stroke performance measures specific to stroke center certification. The state of Kentucky’s experience and utilization of the Institute for Healthcare Improvement Breakthrough Series model with key strategies for success will be discussed to serve as a foundation and empower novice stroke leaders in learning health systems. The models may be adapted internationally for application to stroke-specific care process improvement locally, regionally, and nationally; among organizations within the same health system or competing systems; and among organizations with funding or without funding to improve stroke performance measures.

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