OBJECTIVE: The aim of this project was to determine whether a tailored multifaceted intervention aimed at site-specific barriers is more effective than audit feedback alone for improving adherence to inhospital stroke performance measures (PMs): door to needle time of less than 1 hour for tissue plasminogen activator, dysphagia screening, deep venous thrombosis prophylaxis, and warfarin treatment for atrial fibrillation. METHODS: Hospitals were paired on baseline adherence to dysphagia screening and quality improvement infrastructure and randomized to receive audit feedback alone (n=7) versus audit feedback plus site-specific interventions (n=6). Data were collected on all admitted patients with stroke seen in the neurology department before and after a 6-month implementation period. The primary end point was the difference in postintervention adherence rates for each PM, except tissue plasminogen activator because of low sample size. RESULTS: Data were collected on 2071 preintervention patients and 1240 postintervention patients. Targeted site-specific interventions, such as standing orders and standardized dysphagia screens, were imperfectly implemented during the 6-month intervention period. For atrial fibrillation, the intervention group had an 11% higher postintervention adherence rate beyond that of the control group (98% v 87%, P < .005). No other statistically significant changes in PM adherence were observed. CONCLUSION: Implementation of site-specific interventions for quality improvement of specific measures in stroke was difficult to achieve in a 6-month time frame and led to improved adherence for only one of 3 PMs. Studies with a longer intervention period and more sites are required to determine whether tailored interventions can enhance stroke improvement. Copyright 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
RCT Entities:
OBJECTIVE: The aim of this project was to determine whether a tailored multifaceted intervention aimed at site-specific barriers is more effective than audit feedback alone for improving adherence to inhospital stroke performance measures (PMs): door to needle time of less than 1 hour for tissue plasminogen activator, dysphagia screening, deep venous thrombosis prophylaxis, and warfarin treatment for atrial fibrillation. METHODS: Hospitals were paired on baseline adherence to dysphagia screening and quality improvement infrastructure and randomized to receive audit feedback alone (n=7) versus audit feedback plus site-specific interventions (n=6). Data were collected on all admitted patients with stroke seen in the neurology department before and after a 6-month implementation period. The primary end point was the difference in postintervention adherence rates for each PM, except tissue plasminogen activator because of low sample size. RESULTS: Data were collected on 2071 preintervention patients and 1240 postintervention patients. Targeted site-specific interventions, such as standing orders and standardized dysphagia screens, were imperfectly implemented during the 6-month intervention period. For atrial fibrillation, the intervention group had an 11% higher postintervention adherence rate beyond that of the control group (98% v 87%, P < .005). No other statistically significant changes in PM adherence were observed. CONCLUSION: Implementation of site-specific interventions for quality improvement of specific measures in stroke was difficult to achieve in a 6-month time frame and led to improved adherence for only one of 3 PMs. Studies with a longer intervention period and more sites are required to determine whether tailored interventions can enhance stroke improvement. Copyright 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Authors: Peter K Lindenauer; Denise Remus; Sheila Roman; Michael B Rothberg; Evan M Benjamin; Allen Ma; Dale W Bratzler Journal: N Engl J Med Date: 2007-01-26 Impact factor: 91.245
Authors: S B Soumerai; T J McLaughlin; J H Gurwitz; E Guadagnoli; P J Hauptman; C Borbas; N Morris; B McLaughlin; X Gao; D J Willison; R Asinger; F Gobel Journal: JAMA Date: 1998-05-06 Impact factor: 56.272
Authors: Rajendra H Mehta; Cecelia K Montoye; Meg Gallogly; Patricia Baker; Angela Blount; Jessica Faul; Canopy Roychoudhury; Steven Borzak; Susan Fox; Mary Franklin; Marge Freundl; Eva Kline-Rogers; Thomas LaLonde; Michele Orza; Robert Parrish; Martha Satwicz; Mary Jo Smith; Paul Sobotka; Stuart Winston; Arthur A Riba; Kim A Eagle Journal: JAMA Date: 2002-03-13 Impact factor: 56.272
Authors: Moira K Kapral; Andreas Laupacis; Stephen J Phillips; Frank L Silver; Michael D Hill; Jiming Fang; Janice Richards; Jack V Tu Journal: Stroke Date: 2004-05-13 Impact factor: 7.914
Authors: Dominique A Cadilhac; Joeseph Ibrahim; Dora C Pearce; Kathryn J Ogden; John McNeill; Stephen M Davis; Geoffrey A Donnan Journal: Stroke Date: 2004-04-01 Impact factor: 7.914
Authors: Susan R Kahn; David R Morrison; Gisèle Diendéré; Alexandre Piché; Kristian B Filion; Adi J Klil-Drori; James D Douketis; Jessica Emed; André Roussin; Vicky Tagalakis; Martin Morris; William Geerts Journal: Cochrane Database Syst Rev Date: 2018-04-24
Authors: Susan R Kahn; Gisele Diendéré; David R Morrison; Alexandre Piché; Kristian B Filion; Adi J Klil-Drori; James Douketis; Jessica Emed; André Roussin; Vicky Tagalakis; Martin Morris; William Geerts Journal: BMJ Open Date: 2019-05-24 Impact factor: 2.692
Authors: Kate Laver; Natasha A Lannin; Peter Bragge; Peter Hunter; Anne E Holland; Emma Tavender; Denise O'Connor; Fary Khan; Robert Teasell; Russell Gruen Journal: BMC Health Serv Res Date: 2014-09-17 Impact factor: 2.655