Quality improvement intervention for stroke care cost effective in China

2020 ◽  
Vol 847 (1) ◽  
pp. 29-29
Keyword(s):  
Quality Improvement ◽  
Cost Effective ◽  
Stroke Care ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

scholarly journals Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1265-1271 ◽  
Author(s):  
Yuesong Pan ◽  
Lei Zhang ◽  
Zixiao Li ◽  
Xia Meng ◽  
Yilong Wang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Stroke Care ◽  
Quality Improvement Intervention ◽  
Life Years ◽  
Chinese Yuan ◽  
Quality Adjusted Life ◽  
Improvement Intervention

Background and Purpose— Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world’s largest low- and middle-income country. Methods— A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results— Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions— A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.

scholarly journals Prescription of blood pressure lowering treatment after intracerebral haemorrhage: Prospective, population-based cohort study

2020 ◽  
pp. 239698732097572
Author(s):  
Karl Bonello ◽  
Amy PK Nelson ◽  
Tom J Moullaali ◽  
Rustam Al-Shahi Salman ◽  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Quality Improvement ◽  
Hospital Discharge ◽  
Intracerebral Haemorrhage ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Population Based ◽  
Quality Improvement Intervention ◽  
Improvement Intervention

Introduction Blood pressure (BP) lowering reduces the risk of recurrent stroke after intracerebral haemorrhage (ICH). However, implementation of BP lowering in clinical practice in the UK is unknown. Patients and methods We identified adults with first-ever incident ICH to quantify the proportion who survived >14 days after hospital discharge and were prescribed BP-lowering medication in a prospective, population-based, inception cohort study in the Lothian region of Scotland during June 2010–May 2012 and January–December 2019. After the first cohort, we analysed reasons for avoiding BP-lowering medication in a sample from the Lothian region of the Scottish Stroke Care Audit during January 2017–November 2017, which informed a quality improvement intervention that was implemented in the second cohort. Results After efforts to improve monitoring and lowering of BP amongst ICH survivors, there was an increase in the proportion of patients prescribed BP-lowering medication at hospital discharge between the first and second population-based cohorts (81/130 [62%] vs. 68/89 [76%]; P = 0.028). Compared with patients not prescribed BP-lowering medication at hospital discharge, patients prescribed BP-lowering medication presented with higher systolic BP (177 vs. 156 mm Hg, P = 0.002 and 180 vs. 149 mm Hg, P < 0.001, in the first and second population-based cohorts, respectively), and were more likely to have pre-morbid hypertension (85% vs. 33%, P < 0.001 and 72% vs. 29%, P < 0.001) and atrial fibrillation (35% vs. 4%, P < 0.001 and 26% vs. 5%, P < 0.034). Conclusion In this population-based study, the proportion of patients with ICH who were prescribed BP-lowering medication at hospital discharge increased after a quality improvement intervention.

Implementation of an in-hospital stroke simulation protocol

2018 ◽  
Vol 31 (6) ◽  
pp. 552-562 ◽  
Author(s):  
Johis Ortega ◽  
Juan M. Gonzalez ◽  
Lila de Tantillo ◽  
Karina Gattamorta
Keyword(s):  
Quality Improvement ◽  
Hospital Setting ◽  
Stroke Care ◽  
University Hospital ◽  
Quality Improvement Intervention ◽  
Hospital Inpatient ◽  
Content Type ◽  
Simulation Protocol ◽  
Simulation Scenario ◽  
Improvement Intervention

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting.

scholarly journals Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya

2021 ◽  
Vol 6 (3) ◽  
pp. e002452
Author(s):  
Meghan Bruce Kumar ◽  
Jason J Madan ◽  
Peter Auguste ◽  
Miriam Taegtmeyer ◽  
Lilian Otiso ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Improvement Intervention ◽  
Skilled Delivery ◽  
Community Healthcare ◽  
Improvement Interventions ◽  
Quality Improvement Interventions ◽  
The Cost ◽  
Improvement Intervention

IntroductionImprovements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya.MethodsWe estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses.ResultsWe found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars).ConclusionsThis analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.

scholarly journals Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Alfred Kwesi Manyeh ◽  
Tobias Chirwa ◽  
Rohit Ramaswamy ◽  
Frank Baiden ◽  
Latifat Ibisomi
Keyword(s):  
Quality Improvement ◽  
Needs Assessment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Northern Ghana ◽  
Quality Improvement Intervention ◽  
Evidence Based ◽  
Context Specific ◽  
Improvement Intervention

Abstract Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.

scholarly journals A quality improvement intervention to reduce emergency department radiography for bronchiolitis

2018 ◽  
Vol 137 ◽  
pp. 1-5 ◽  
Author(s):  
Joel Reiter ◽  
Adin Breuer ◽  
Oded Breuer ◽  
Saar Hashavya ◽  
David Rekhtman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Quality Improvement Intervention ◽  
Improvement Intervention
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