Associations Between Adherence to Evidence-Based, Stroke Quality Indicators and Outcomes of Acute Reperfusion Therapy

Abstract

Background: Quality indicators (QIs) are an accepted tool for measuring a hospital’s performance in routine care. We examined national trends in adherence to the QIs developed by the Close The Gap-Stroke program by combining data from the health insurance claims database and electronic medical records, and the association between adherence to these QIs and early outcomes in patients with acute ischemic stroke in Japan. Methods: In the present study, patients with acute ischemic stroke who received acute reperfusion therapy in 351 Close The Gap-Stroke-participating hospitals were analyzed retrospectively. The primary outcomes were changes in trends for adherence to the defined QIs by difference-in-difference analysis and the effects of adherence to distinct QIs on in-hospital outcomes at the individual level. A mixed logistic regression model was adjusted for patient and hospital characteristics (eg, age, sex, number of beds) and hospital units as random effects. Results: Between 2013 and 2017, 21 651 patients (median age, 77 years; 43.0% female) were assessed. Of the 25 defined measures, marked and sustainable improvement in the adherence rates was observed for door-to-needle time, door-to-puncture time, proper use of endovascular thrombectomy, and successful revascularization. The in-hospital mortality rate was 11.6%. Adherence to 14 QIs lowered the odds of in-hospital mortality (odds ratio [95% CI], door-to-needle <60 min, 0.80 [0.69–0.93], door-to-puncture <90 min, 0.80 [0.67–0.96], successful revascularization, 0.40 [0.34–0.48]), and adherence to 11 QIs increased the odds of functional independence (modified Rankin Scale score 0–2) at discharge. Conclusions: We demonstrated national marked and sustainable improvement in adherence to door-to-needle time, door-to-puncture time, and successful reperfusion from 2013 to 2017 in Japan in patients with acute ischemic stroke. Adhering to the key QIs substantially affected in-hospital outcomes, underlining the importance of monitoring the quality of care using evidence-based QIs and the nationwide Close The Gap-Stroke program.

Correlation of Quality Metrics of Acute Stroke Care with Clinical Outcomes in an Indian Tertiary-care University Hospital: A Prospective Evidence-based Study

“… 7 , 10 Both the cerebrovascular event groups developed stroke at relatively younger ages compared to the reports from the Western population. The patients in the present study were younger by an average of 10–12 years than the median age reported by the GWTG-stroke study (United States), 10 the China Stroke Center Alliance (CSCA)-stroke study (China), 17 Close the GAP-stroke study (Japan), 18 and the Arbeitsgemeinschaft Deutschsprachiger Schlaganfall Register (ADSR): stroke study (Germany) 19 patients. Comparable age demographics were observed in the IUCSP-stroke study (India).…”

“… 16 The gender distribution in the present study showed a male preponderance (>75%), similar to other studies. 13 , 16 – 18 However, this was not the case in the GWTG-stroke study patients where 52.4% of females had IS and 49.3% had ICH. 10 There was a relatively high burden of modifiable risk factors in both the cerebrovascular event groups.…”

Projections of future coronary heart disease and stroke mortality in Japan until 2040: a Bayesian age-period-cohort analysis

“…Firstly, most major cardiovascular risk factors have been improved in Japan, such as decreases in mean systolic blood pressure (−8.87 mmHg) and smoking prevalence (−14%) between 1980 and 2012 except total cholesterol level, and prevalence of obesity and diabetes. 8 Secondly comes the increasing and adhering use of evidence-based medical and surgical treatments, including angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers for CHD, 8 and endovascular thrombectomy and shortening door-to-needle time (<60 min, as a meaningful quality indicator) for acute ischemic stroke, 26 , 27 along with lower in-hospital stroke mortality rates observed in hospitals with comprehensive stroke care capabilities in Japan. 28 However, the ongoing reduction in CVD mortality in Japan may be jeopardised by the increasing prevalence of obesity and diabetes.…”

Trilobatin attenuates cerebral ischemia/reperfusion-induced blood-brain-barrier dysfunction by targeting MMP9: The legend of a food additive

“…Ischemic stroke is a debilitating neurological disorder of morbidity, mortality and ponderous socio-economic burden elicited by the break of cerebral blood flow (Ren et al, 2022). Notwithstanding the prominence as a principal cause of disability and death, efficacious treatments currently are still limited to overcome cerebral ischemic stroke.…”