Evaluation of a Multilevel Program to Improve Clinician Adherence to Management Guidelines for Acute Ischemic Stroke

Chen, Yi; Gong, Xiaoxian; Zhong, Wansi; Wang, Jianbing; Yang, Zongming; Yan, Shiyu; Geng, Fangli; Zhou, Ying; Zhang, Xuting; Chen, Zhicai; Hu, Haitao; Tong, Lifang; Chen, Hongfang; Ke, Shaofa; He, Yuehui; Wang, Yaxian; Wang, Zhimin; Chen, Zhihui; Zhao, Heng; Yuan, Changzheng; Lou, Min

doi:10.1001/jamanetworkopen.2022.10596

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…Recent published multilevel program used similar quality improvement strategies and confirmed the effectiveness of regional stroke network. 11…”

Section: Discussionmentioning

confidence: 99%

“…Recent published multilevel program used similar quality improvement strategies and confirmed the effectiveness of regional stroke network. 11 Regional stroke networks have been studied in the United States, including GWTG-Stroke program 4,12 and the Paul Coverdell Stroke Program, 13,14 both focused on increased stroke awareness and prevention, and enhanced collaboration among states to reduce the stroke burden. The 4S regional network instead focused on quality improvement by addressing physicians' adherence to evidencebased performance metrics.…”

Section: Discussionmentioning

confidence: 99%

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Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project

Xie

Fang

et al. 2022

International Journal of Stroke

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Background: In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge. Aims: To determine whether the intervention by Shanghai Stroke Service System (4S) has helped to improve adherence to stroke-care guidelines and patient outcome. Methods: 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality. Results: The study enrolled 92,395 patients (mean age 69.0±12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018-2020 than those between 2015-2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95%CI [2.7% to 3.2%], P<0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95%CI [2.7% to 4.2%], P<0.001). Further analysis of individual KPIs showed an absolute increase in 6 KPIs ranging from 3.4% to 8.9% (P<0.001 for all comparisons). Compared to 2015-2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference -1.08, 95%CI [-1.18 to -0.99], P<0.001) and in-hospital mortality was significantly reduced (RR 0.88, 95% CI [0.79–0.98]; P=0.01) in 2018-2020. Conclusions: The 4S intervention was associated with increased adherence to the stroke-care guidelines, which further translated to improved clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT02735226

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“…Recent published multilevel program used similar quality improvement strategies and confirmed the effectiveness of regional stroke network. 11…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project

Xie

Fang

et al. 2022

International Journal of Stroke

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“…Each center has dedicated personnel who receive specialized training from us. An automated chart data capture system subsequently scans the inpatient records of enrolled cases from each center, facilitating data extraction [ 14 , 15 ]. Our trained investigators oversee the authenticity and reliability of this data.…”

Section: Methodsmentioning

confidence: 99%

Association of Atrial Fibrillation with Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results from a Multicenter Study in China

Pan,

Pei,

Zhang

et al. 2023

Neurol Ther

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Introduction This study aimed to investigate the association between atrial fibrillation (AF), particularly newly diagnosed AF, and remote intracerebral hemorrhage (rICH) in patients with ischemic stroke who were treated with intravenous thrombolysis (IVT). Methods This observational study was conducted on patients with ischemic stroke who received IVT with recombinant tissue-type plasminogen activator. The data were taken from a multicenter prospective registry of a Chinese population. rICH was defined as any extraischemic hemorrhage detected on computerized tomography (CT) 24 h after intravenous thrombolysis. We collected and compared the demographic data and clinical characteristics of all the patients with rICH to those of patients without any type of hemorrhagic transformation. The association between AF and rICH was analyzed using univariate analysis and binary logistic regression. Results A total of 20,697 patients were included in the study, with 1566 (7.6%) experiencing intracerebral hemorrhage (ICH), 586 (2.8%) experiencing rICH, and 19,131 (92.4%) not experiencing any form of hemorrhagic transformation. Univariate analysis revealed significant differences in age, pre-thrombolysis systolic blood pressure, baseline National Institute of Health Stroke Scale score, previously known AF, newly diagnosed AF, coronary heart disease, congestive heart failure, hyperhomocysteinemia, and history of thrombolysis between the rICH and control groups ( P < 0.05). Further multivariate logistic regression analysis indicated that total AF (OR 1.821, 95% CI 1.082–3.065, P < 0.05), previously known AF (OR 1.470, 95% CI 1.170–1.847), and newly diagnosed AF (OR 1.920, 95% CI 1.304–2.825) were independently associated with rICH. Conclusions This study suggests that AF, regardless of whether it is newly diagnosed or previously known, may be associated with the occurrence of rICH following intravenous thrombolysis. Interestingly, our findings suggest that newly diagnosed AF may have a stronger impact on rICH than previously known AF, although confirmation from more studies is needed. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-023-00563-9.

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“…Four studies successfully used external facilitation as part of a multicomponent intervention alongside other implementation strategies. 1,2,4,10 However, the professional backgrounds, core activities, mode of delivery, and the amount of involvement of the external facilitators varied. The external facilitation of the program implemented in 58 hospitals in China to improve acute stroke care included monthly videoconferencing with local hospitals.…”

Section: External Facilitation: Learning From Othersmentioning

confidence: 99%

“…The external facilitation of the program implemented in 58 hospitals in China to improve acute stroke care included monthly videoconferencing with local hospitals. 10 These workshops focused on continuing education, monitoring and feedback, and collaborative problem solving. A study from Australia to improve acute stroke care included 2 externally facilitated workshops (via videoconference and in person) focused on data feedback to identify gaps in care, education, barrier assessment, and collaborative action plan development.…”

Section: External Facilitation: Learning From Othersmentioning

confidence: 99%

Advances in Stroke: Quality Improvement

Bravata

Purvis

Ding

et al. 2023

Stroke

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Evaluation of a Multilevel Program to Improve Clinician Adherence to Management Guidelines for Acute Ischemic Stroke

Abstract: This quality improvement study evaluates the outcomes associated with a program to improve clinician adherence to management guidelines for acute ischemic stroke in hospitals in China.

Cited by 3 publications

References 23 publications

Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project

Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project

Association of Atrial Fibrillation with Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results from a Multicenter Study in China

Advances in Stroke: Quality Improvement

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