Yilong Wang1,2, Zixiao Li3,2, Xingquan Zhao3,2, Liping Liu4,5, Chunxue Wang3,6, Chunjuan Wang1,6, Eric D Peterson6, Lee H Schwamm7, Gregg C Fonarow8, Sidney C Smith9, Janet Bettger6,10, David Wang11, Hao Li1,2, Ying Xian6, Yongjun Wang1,3,2,5,6. 1. TianTan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, China (Yilong Wang, Chunjuan Wang, H.L., Yongjun Wang). 2. China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Z.L., X.Z., H.L., Yongjun Wang). 3. Vascular Neurology, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, China (Z.L., X.Z., Chunxue Wang, Yongjun Wang). 4. Neuro Intensive Care Unit, Department of Neurology, Beijing TianTan Hospital, Capital Medical University, China (L.L.). 5. Center of Stroke, Beijing Institute for Brain Disorders, China (L.L., Yongjun Wang). 6. Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunxue Wang, Chunjuan Wang, Yongjun Wang). 7. Duke Clinical Research Institute (DCRI), Durham, NC (E.D.P., J.B., Y.X.). 8. Massachusetts General Hospital, Boston (L.H.S.). 9. Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill (S.C.S.). 10. Duke University School of Nursing, Durham, NC (J.B.). 11. INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.).
Abstract
BACKGROUND: Stroke is the leading cause of death in China. Despite the wide dissemination of evidence-based guidelines, data about adherence to these in routine clinical practice are scarce. We conducted a study using a nationwide registry to evaluate the implementation of evidence-based stroke performance indicators and associated guidelines, for patients with an ischemic stroke in China. METHODS AND RESULTS: The China National Stroke Registry is a prospective cohort study, including 12 416 patients diagnosed with acute ischemic stroke from 132 hospitals across China, for 1 year beginning September 2007. Twelve performance indicators were selected to evaluate the quality of stroke care. Multivariable Cox models were used to determine the association between optimal compliance and clinical outcomes. Conformity with performance measures ranged from a median of 6.5% for the use of intravenous tPA (tissue-type plasminogen activator) to 81.8% for early use of antithrombotics. The optimal compliance with all in-hospital measures was associated with 1-year death after admission (hazard ratio, 0.66; 95% CI, 0.55-0.79). The optimal compliance with all discharge measures was associated with the 1-year death after discharge (hazard ratio, 0.55; 95% CI, 0.44-0.69), 1-year stroke recurrence (hazard ratio, 0.81; 95% CI, 0.70-0.93), and favorable functional outcomes (defined as modified Rankin Scale score of ≤2) (hazard ratio, 1.10; 95% CI, 1.04-1.16). CONCLUSIONS: Adherence to evidence-based ischemic stroke care measures in China revealed substantial gaps, and select measures were associated with improved outcomes. These findings support the need for ongoing quality measurement and improvement in stroke care in China.
BACKGROUND:Stroke is the leading cause of death in China. Despite the wide dissemination of evidence-based guidelines, data about adherence to these in routine clinical practice are scarce. We conducted a study using a nationwide registry to evaluate the implementation of evidence-based stroke performance indicators and associated guidelines, for patients with an ischemic stroke in China. METHODS AND RESULTS: The China National Stroke Registry is a prospective cohort study, including 12 416 patients diagnosed with acute ischemic stroke from 132 hospitals across China, for 1 year beginning September 2007. Twelve performance indicators were selected to evaluate the quality of stroke care. Multivariable Cox models were used to determine the association between optimal compliance and clinical outcomes. Conformity with performance measures ranged from a median of 6.5% for the use of intravenous tPA (tissue-type plasminogen activator) to 81.8% for early use of antithrombotics. The optimal compliance with all in-hospital measures was associated with 1-year death after admission (hazard ratio, 0.66; 95% CI, 0.55-0.79). The optimal compliance with all discharge measures was associated with the 1-year death after discharge (hazard ratio, 0.55; 95% CI, 0.44-0.69), 1-year stroke recurrence (hazard ratio, 0.81; 95% CI, 0.70-0.93), and favorable functional outcomes (defined as modified Rankin Scale score of ≤2) (hazard ratio, 1.10; 95% CI, 1.04-1.16). CONCLUSIONS: Adherence to evidence-based ischemic stroke care measures in China revealed substantial gaps, and select measures were associated with improved outcomes. These findings support the need for ongoing quality measurement and improvement in stroke care in China.
Entities:
Keywords:
cause of death; hospitalization; hospitals; informed consent; recurrence
Authors: Mustapha Mohammed; Hadzliana Zainal; Balamurugan Tangiisuran; Sabariah N Harun; Siti M Ghadzi; Irene Looi; Norsima N Sidek; Keng L Yee; Zariah A Aziz Journal: Pharm Pract (Granada) Date: 2020-03-09