TY - JOUR
T1 - Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China
T2 - A randomized clinical trial
AU - GOLDEN BRIDGE - AIS Investigators
AU - Wang, Yongjun
AU - Wang, Yilong
AU - Li, Zixiao
AU - Zhao, Xingquan
AU - Wang, Chunjuan
AU - Wang, Xianwei
AU - Wang, David
AU - Liang, Li
AU - Liu, Liping
AU - Wang, Chunxue
AU - Li, Hao
AU - Shen, Haipeng
AU - Bettger, Janet
AU - Pan, Yuesong
AU - Jiang, Yong
AU - Yang, Xiaomeng
AU - Zhang, Changqing
AU - Han, Xiujie
AU - Meng, Xia
AU - Yang, Xin
AU - Kang, Hong
AU - Yuan, Weiqiang
AU - Fonarow, Gregg C.
AU - Peterson, Eric D.
AU - Schwamm, Lee H.
AU - Xian, Ying
N1 - Funding Information:
Funding/Support: This study was supported by grants from the Ministry of Science and Technology and the Ministry of Health of the People’s Republic of China (NationalS&T Major Project of China: 2011BAI08B02, 2012ZX09303, 2013BAI09B14, 2013BAI09B03, 2015BAI12B02, 2015BAI12B04, 2016YFC0901000, 2016YFC0901002, 2017YFC1307900, 2017YFC1307905, 2017YFC1310900, 2017YFC1310901, and 2017YFC1310903); Beijing Municipal Committee of Science and Technology (D15110700200000, D151100002015001, D151100002015002, Z161100000516223, and Z141107002514125); Beijing Institute for Brain Disorders (BIBD-PXM2013_014226_07_000084); Beijing Key Laboratory for Cerebrovascular Disease (BZ0101); University of Hong Kong Stanley Ho Alumni Challenge Fund; University of Hong Kong Research Committee Seed Funding Award (104004215); and Sanofi.
Funding Information:
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Bettger reported consulting for the Ohio Department of Health and serving on committees for the Centers for Disease Control and Prevention (CDC) Paul Coverdell National Acute Stroke Stroke Registry. Dr Peterson reported being a principal investigator of the data coordinating and analysis center for the American Heart Association/ American Stroke Association’s Get With the Guidelines (GWTG). Dr Fonarow reported being a member of the GWTG steering committee and receiving grant funding from Patient-Centered Outcomes Research Institute and the National Institutes of Health. Dr Schwamm reported being the chair of the GWTG-Stroke Clinical Workgroup of the American Heart Association and principal investigator of a National Institute of Neurological Disorders and Stroke (NINDS)–funded clinical trial; grant funding and nonfinancial support from Genentech; and consulting for the Joint Commission, CDC, and the Massachusetts Department of Public Health. No other disclosures were reported.
Funding Information:
This study was supported by grants from the Ministry of Science and Technology and the Ministry of Health of the People's Republic of China (NationalS&TMajor Project of China: 2011BAI08B02, 2012ZX09303, 2013BAI09B14, 2013BAI09B03, 2015BAI12B02, 2015BAI12B04, 2016YFC0901000, 2016YFC0901002, 2017YFC1307900, 2017YFC1307905, 2017YFC1310900, 2017YFC1310901, and 2017YFC1310903); Beijing Municipal Committee of Science and Technology (D15110700200000, D151100002015001, D151100002015002, Z161100000516223, and Z141107002514125); Beijing Institute for Brain Disorders (BIBD-PXM2013-014226-07-000084); Beijing Key Laboratory for Cerebrovascular Disease (BZ0101); University of Hong Kong StanleyHo Alumni Challenge Fund; University of Hong Kong Research Committee Seed FundingAward (104004215); and Sanofi.
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/7/17
Y1 - 2018/7/17
N2 - IMPORTANCE In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited. OBJECTIVE To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) in China. DESIGN, SETTING, AND PARTICIPANTS A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016. INTERVENTIONS Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback. Twenty hospitals participated in the stroke registry with usual care (control group; 2400 patients). MAIN OUTCOMES AND MEASURES The primary outcomewas hospital personnel adherence to 9 AIS performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to, and as all-or-none. Secondary outcomes included in-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months. RESULTS Among4800patients with AIS enrolled from40hospitals and randomized (mean age, 65 years;women, 1757 [36.6%]), 3980 patients (82.9%) completed the 12-month follow-up of the trial. Patients in intervention groupwere more likely to receive performance measures than those in the control groups (composite measure, 88.2%vs 84.8%, respectively; absolute difference,3.54%[95%CI,0.68%to6.40%],P =.02). Theall-or-nonemeasuredidnotsignificantly differ between the intervention and control groups (53.8% vs 47.8%, respectively; absolute difference, 6.69%[95%CI, -0.41%to 13.79%], P =.06). Newclinical vascular eventswere significantly reduced in the intervention group compared with the control group at 3 months (3.9%vs 5.3%,respectively; difference, -2.03%[95%CI, -3.51%to-0.55%];P =.007),6months (6.3%vs7.8%, respectively; difference,-2.18%[95%CI,-4.0%to-0.35%];P =.02)and12months (9.1%vs 11.8%, respectively; difference, -3.13%[95%CI, -5.28%to -0.97%]; P =.005). CONCLUSIONSANDRELEVANCE Among40hospitals in China, amultifaceted qualityimprovement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Further research is needed to understand the generalizability of these findings.
AB - IMPORTANCE In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited. OBJECTIVE To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) in China. DESIGN, SETTING, AND PARTICIPANTS A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016. INTERVENTIONS Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback. Twenty hospitals participated in the stroke registry with usual care (control group; 2400 patients). MAIN OUTCOMES AND MEASURES The primary outcomewas hospital personnel adherence to 9 AIS performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to, and as all-or-none. Secondary outcomes included in-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months. RESULTS Among4800patients with AIS enrolled from40hospitals and randomized (mean age, 65 years;women, 1757 [36.6%]), 3980 patients (82.9%) completed the 12-month follow-up of the trial. Patients in intervention groupwere more likely to receive performance measures than those in the control groups (composite measure, 88.2%vs 84.8%, respectively; absolute difference,3.54%[95%CI,0.68%to6.40%],P =.02). Theall-or-nonemeasuredidnotsignificantly differ between the intervention and control groups (53.8% vs 47.8%, respectively; absolute difference, 6.69%[95%CI, -0.41%to 13.79%], P =.06). Newclinical vascular eventswere significantly reduced in the intervention group compared with the control group at 3 months (3.9%vs 5.3%,respectively; difference, -2.03%[95%CI, -3.51%to-0.55%];P =.007),6months (6.3%vs7.8%, respectively; difference,-2.18%[95%CI,-4.0%to-0.35%];P =.02)and12months (9.1%vs 11.8%, respectively; difference, -3.13%[95%CI, -5.28%to -0.97%]; P =.005). CONCLUSIONSANDRELEVANCE Among40hospitals in China, amultifaceted qualityimprovement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Further research is needed to understand the generalizability of these findings.
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U2 - 10.1001/jama.2018.8802
DO - 10.1001/jama.2018.8802
M3 - Article
C2 - 29959443
AN - SCOPUS:85050406827
VL - 320
SP - 245
EP - 254
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0098-7484
IS - 3
ER -