Abstract WP284: Regional Disparities in the Quality of Stroke Care

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Seth Seabury ◽  
Katalin Bognar ◽  
Yaping Xu ◽  
Caroline Huber ◽  
S. R Commerford ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Stroke Care ◽  
Performance Measure ◽  
Care Quality ◽  
Measure Data ◽  
Quality Reporting ◽  
Urban Rural ◽  
Stroke Center ◽  
Hospital Compare

Background: Geographic variation in healthcare quality, including an urban-rural difference, is well recognized. For stroke care, we were interested in the relationship with stroke center certification and access to neurological services. Hypothesis: We assessed the hypothesis that the use of thrombolytic therapy (t-PA) is associated with stroke certification level and access to neurological services. Methods: Performance measure data in the 2015 Hospital Compare, a CMS quality reporting system, were used to document the gap in care quality among hospitals according to large, medium, small-metro, and non-metro areas and Joint Commission (JC) certification. Regression analysis was used to estimate the association between t-PA use and certification level or access to neurological services. Results: On average, non-metro hospitals performed worse than metro hospitals on JC-endorsed stroke quality measures; the biggest disparity was in the use of t-PA for eligible patients arriving within 2 hours (STK-4). Certified stroke centers in every geographic designation provided higher quality of care; however, a large variation was observed among non-certified hospitals (Figure). Regression analysis suggested that improvements in certification or access were associated with 45% and 21% absolute improvements, respectively, in the percent of patients receiving t-PA (Table). Conclusion: The large quality gap in stroke care between metro and non-metro areas can, in part, be addressed by approaches to achieve stroke center certification or to adopt decision support systems such as telemedicine.

Abstract W MP104: Quality of Acute Stroke Care at Primary Stroke Centers Before and After Certification in Comparison to Never-Certified Hospitals

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
David S Liebeskind ◽  
Justina Breen ◽  
Scott Hamilton ◽  
...  
Keyword(s):  
Los Angeles ◽  
Acute Stroke ◽  
Stroke Care ◽  
Care Quality ◽  
Acute Stroke Care ◽  
Phase 3 ◽  
Before And After ◽  
Beneficial Impact ◽  
Mean Time

Background: Primary Stroke Centers (PSC) provide better acute stroke care than non-PSC hospitals, including faster times to imaging and lytic treatment, and higher rates of lytic delivery. Nationwide less than 1 in 3 hospital has achieved this designation. We aimed to determine the extent to which the better performance at PSC is driven by improvements within hospitals after PSC designation versus better baseline hospital care among facilities seeking PSC certification. Methods: From 2005 to 2012, the NIH Field Administration of Stroke Therapy -Magnesium (FAST-MAG) Phase 3 clinical trial enrolled subjects with likely stroke within 2 hours of onset in a study of prehospital start of a neuroprotective agent. Subjects were routed to 59 community and academic centers in Los Angeles and Orange Counties. Of the original 59 centers, 39 eventually achieved PSC status during the study period. Each subject was classified as enrolled at a PSC before certification (pre-PSC), at a PSC post certification (post-PSC), or at a hospital that never achieved PSC (non-PSC). Results: Of 1700 cases, 529 (31%) were enrolled at pre-PSC, 856 (50%) at post-PSC, and 315 (19%) at non-PSC hospitals. Mean time in minutes from ED arrival to first scan was 33 minutes at post-PSC, 47 minutes at pre-PSC and 49 at non-PSCs [p<0.001 by Mann-Whitney]. Among cases of cerebral ischemia (CI) [N=1223], rates of TPA utilization were 43% at post-PSC, 27% at pre-PSC and 28% at non-PSC hospitals [p<0.001 by X2]. Time in minutes from ED arrival to thrombolysis in treated cases was 71 at post-PSC, 98 at pre-PSC, and 95 at non-PSC hospitals [p<0.001 by Mann-Whitney]. Hospitals that achieved PSC showed improvements in pre-PSC and post-PSC performance on door to imaging time, from 47 to 33 minutes [p=0.014]; percent TPA use in CI, from 27% to 43% [p<0.001], and reduced door-to-needle times, from 98 to 71 minutes [p=0.003]. There was no difference in time to imaging [47 vs. 49 minutes], time to thrombolysis [98 vs. 95 minutes] and percent TPA use [27% vs. 28%] between pre-PSC hospitals and non-PSC hospitals. Conclusions: Better performance of Primary Stroke Centers on acute care quality metrics is primarily driven by a beneficial impact of the PSC-certification process, and not better performance prior to seeking PSC status.

Abstract 371: Stroke Healthcare Quality and Outcomes in Different Level of Stroke Centers

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Yang Xin
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Performance Measures ◽  
Healthcare Quality ◽  
Stroke Care ◽  
Care Quality ◽  
Composite Measure ◽  
Stroke Patients ◽  
Hospital Outcomes ◽  
Stroke Center

Background: Evidences support the stroke centers, including primary stroke center (PSC) and comprehensive stroke center (CSC) to improve stroke patient healthcare and outcomes. Objects: We aimed to compare stroke healthcare quality and in-hospital outcomes between CSCs and PSCs in China. Methods: Data were collected from acute stroke patients who were admitted to CSCs or PSCs that participated in the China Stroke Center Alliance (CSCA) program. Stroke care quality performances include: intravenous rtPA or endovascular thrombolysis (EVT) therapy in acute ischemic stroke (IS) patients, neurosurgical procedures of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) patients, secondary prevention measures (such as medicines, dysphagia screening, rehabilitation assessment) in stroke patients. Performances of above were assessed by all-or-none measure and composite measure. The former was defined as the proportion of patients who received all the performance measures for which the patient was eligible. The latter was defined as the total number of eligible performance measures performed divided by the total number of performance measures for which a given patient was eligible. The composite measure was calculated for each patient and then averaged. Outcome was mainly estimated by in-hospital mortality. Multivariable logistic regression models were used to analyze the performances of stroke care quality and in-hospital outcomes between CSC and PSC. Results: From 1st Aug, 2015 to 31st July, 2019, 750594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. The mean age of patients was 65.8 (SD 12.2) years old, and 62.5% (469308) were male. By multivariable logistic regression analysis, patient characteristics (age, gender, NIHSS or GCS score, smoking and all the medical histories) and hospital characteristics (hospital level and location) were adjusted, patients in CSCs had higher all-or-none measure (adjusted OR, 1.22 [95%CI, 1.11 to 1.35]). Compared to PSCs, IS patients at CSCs were more likely to receive IV rtPA or EVT therapy (adjusted OR, 1.31 [95%CI, 1.27 to 1.35]; adjusted OR, 1.43 [95%CI, 1.31 to 1.57]), more ICH and SAH patients received neurosurgery (adjusted OR, 1.70 [95%CI, 1.58 to 1.83]; adjusted OR, 1.29 [95%CI, 1.14 to 1.46]). While, CSCs had higher in-hospital mortality than PSCs (adjusted OR, 1.33 [95%CI, 1.23 to 1.43]), especially in ICH patients (adjusted OR, 1.77 [95%CI, 1.54 to 2.03]). Conclusions: CSCs achieved higher care quality for stroke patients but lower risk-adjusted in-hospital mortality. The results might be instructive in improving the care quality in different types of stroke.

Improving Knowledge and Information Sharing to Promote Best Practices in Stroke Care

2013 ◽  
Vol 2 (1) ◽  
pp. 11-25 ◽  
Author(s):  
Elizabeth Sternke ◽  
Nicholas Burrus ◽  
Virginia Daggett ◽  
Laurie Plue ◽  
Katherine Carlson ◽  
...  
Keyword(s):  
Best Practices ◽  
Qualitative Interviews ◽  
Stroke Care ◽  
Care Quality ◽  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Geographically Dispersed ◽  
User Friendly

Despite many advances in stroke care treatment, there is substantial room for improvement in quality of care for stroke patients. In an attempt to disseminate up-to-date quality information and evidence-based best practices of stroke care, the Veterans Health Administration (VHA)and the VHA Stroke QUERI implemented an innovative web-based toolkit tailored for providers and program planners interested in improving stroke care quality. This study evaluated the VA Stroke QUERI Toolkit to determine its most useful aspects and those that require improvement. In-depth qualitative interviews (n = 48) were conducted with a geographically dispersed sample of clinicians and program planners throughout the VHA system. Findings suggest the Stroke QUERI toolkit was perceived as an effective, efficient and user-friendly site but knowledge of the toolkit continues to be initiated and shared mainly through individuals and small groups. To achieve greater impact a comprehensive set of strategies designed to encourage broader uptake is required.

Stroke prevention and control system in China: CSPPC-Stroke Program

2020 ◽  
pp. 174749302091355
Author(s):  
Bao-Hua Chao ◽  
Feng Yan ◽  
Yang Hua ◽  
Jian-Min Liu ◽  
Yi Yang ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Prevention And Control ◽  
Mainland China ◽  
Stroke Care ◽  
Prevention Project ◽  
Hospital Transfer ◽  
Stroke Center ◽  
And Control

In China, stroke is a major cause of mortality, and long-term physical and cognitive impairment. To meet this challenge, the Ministry of Health China Stroke Prevention Project Committee (CSPPC) was established in April 2011. This committee actively promotes stroke prevention and control in China. With government financial support of 838.4 million CNY, 8.352 million people from 536 screening points in 31 provinces have received stroke screening and follow-up over the last seven years (2012–2018). In 2016, the CSPPC issued a plan to establish stroke centers. To shorten the pre-hospital period, the CSPPC established a stroke center network, stroke map, and stroke “Green Channel” to create three 1-h gold rescue circles, abbreviated as “1-1-1” (onset to call time <1 h; pre-hospital transfer time < 1 h, and door-to-needle time < 1 h). From 2017 to 2018, the median door-to-needle time dropped by 4.0% (95% confidence interval (CI), 1.4–9.4) from 50 min to 48 min, and the median onset-to-needle time dropped by 2.8% (95% CI, 0.4–5.2) from 180 min to 175 min. As of 31 December 2018, the CSPPC has established 380 stroke centers in mainland China. From 1 November 2018, the CSPPC has monitored the quality of stroke care in stroke center hospitals through the China Stroke Data Center Data Reporting Platform. The CSPPC Stroke program has led to a significant improvement in stroke care. This program needs to be further promoted nationwide.

scholarly journals Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators

2021 ◽  
Vol 3 (1) ◽  
pp. 9-15
Author(s):  
Khaled Awawdi ◽  
Carmel Armon ◽  
Itzhak Kimiagar ◽  
Mahdi Tarabeih ◽  
Riad Abu Rakia
Keyword(s):  
Quality Of Life ◽  
Quality Indicators ◽  
Stroke Care ◽  
Care Quality ◽  
Care Process ◽  
Life Outcomes ◽  
Post Discharge ◽  
Stroke Treatment ◽  
Quality Of Life Outcomes

Background: In 2013 the Israel Ministry of Health identified the care and treatment of acute cerebral ischemic stroke as failing to achieve expected standards. The Ministry decided to raise standards by defining and instituting, nationwide, a battery of linked care quality indicators to be applied across all relevant facilities and contexts. Five indicators were selected for five key junctures in the AIS care process. Methods: This paper presents and analyses the effects of the implementation of these new care quality indicators on the post-discharge quality of life outcomes of Israeli stroke sufferers. The patient sample comprises patients from Israel’s Central region, where stroke care provision and access is relatively high, and from the peripheral North region, where provision and access are limited. Results: Those who were not treated with thrombolytic treatment and/or cerebral blood vessel catheterization, those who suffered severer strokes, women, the older age groups, non-Jews and North region residents display significantly worse physical functioning outcomes and worse quality of life outcomes on all indicators. Conclusions: Stroke care access and provision disparities translate into significantly higher rates of post-discharge disability, impaired physical and social functioning, and a lower quality of life. The effectiveness of healthcare improvement by the deployment of care indicators is closely associated with the lifestyle, socio-demographic and socioeconomic status of different population groups. The effective implementation of quality care indicators also relies heavily on closing the access and provision gaps between the populations living in central and peripheral areas. Two obvious directions for action are to expand and improve the rehabilitation care network and to combat the age discrimination in hospital stroke treatment.

Abstract 122: Quality of Care for Patients With Acute Ischemic Stroke as a Function of Hospital Intravenous Thrombolysis With Recombinant Tissue Plasminogen Activator Capability: Insights From China National Stroke Registry II

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Zhenzhen Rao ◽  
Zixiao Li ◽  
Hongqiu Gu ◽  
Yilong Wang ◽  
Yongjun Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Care Quality ◽  
Composite Score ◽  
Stroke Patients ◽  
Stroke Registry

Background: Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator (rt-PA) availability at Chinese hospitals varies and may affect care quality for acute ischemic stroke patients. Limited research has shown whether there were differences in quality of care at China National Stroke Registry (CNSR II) hospitals based on rt-PA capability. Methods: For acute ischemic stroke patients admitted to CNSR II hospitals between 2012 and 2013, care quality at hospitals with or without Intravenous rt-PA capability was examined by evaluating conformity with performance and quality measures. The primary outcome was guideline-concordant care, defined as compliance with 10 predefined individual guideline-recommended performance metrics and composite score. A composite score was defined as the total number of interventions actually performed among eligible patients divided by the total number of recommended interventions among eligible patients. Propensity score matching was used to balance the baseline characteristics. We used cox model with shared frailty model and logistic regression with generalized estimating equation to compare the relationship between hospitals with rt-PA capability and hospitals without rt-PA on quality measures. Results: This study included 19604 acute ischemic stroke patients admitted to 219 CNSR II hospitals. Before matching, there were 7928 patients admitted to 86 (40.4%) hospitals with rt-PA capability and 11676 patients admitted to 133 (59.6%) hospitals without rt-PA capability. After matching, 7606 pairs of patients in rt-PA-capable hospitals and rt-PA-incapable hospitals were analyzed. Before matching, the composite score of guideline-concordant process of care was higher at hospitals with rt-PA capability than hospitals without rt-PA capability (74% versus 73%, P=0.0126). Hospitals with rt-PA capability were more likely to perform deep vein thrombosis prophylaxis within 48 hours of admission, dysphagia screening, assessment or receiving of rehabilitation, discharge antithrombotic, anticoagulation for atrial fibrillation and medications for lowering low-density lipoprotein (LDL) ≥100mg/dL. But hospitals with rt-PA capability were less likely to perform antithrombotic medication within 48 hours of admission and hypoglycemic therapy at discharge for patients with diabetes. After matching, differences of stroke care quality between hospitals with rt-PA capability and without rt-PA capability still exist after adjusting covariates. Conclusions: The CNSR II hospitals were associated with better performance in some of the hospitals but not all of them. The difference in conformity between rt-PA-capable hospitals and rt-PA-incapable hospitals was modest for performance measures of stroke care. However, more room for improvement still exists in key quality performance measures and further studies should be explored.

Abstract TP284: Implementation of an Organized Stroke Care Program Reduced Door-to-needle Time in a Hospital in Mexico City

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Juan Calleja ◽  
Jesus Martinez ◽  
Isabel Gutierrez
Keyword(s):  
Care Program ◽  
Quality Measures ◽  
Stroke Care ◽  
Number Of Patients ◽  
Center Care ◽  
Before And After ◽  
Time Parameters ◽  
Stroke Center ◽  
Get With The Guidelines

Introduction: Reperfusion therapies are the optimal treatment for acute ischemic stroke (AIS). Their effectiveness is highly time-dependent. Worldwide, organized stroke care has shown to improve efficiency and quality of attention in stroke management. Neither reperfusion therapies or stroke center care have been widely implemented in Mexico. The objective of this study is to describe whether the implementation of a Stroke Care Program (ABC Stroke Center) improved time to treatment and adherence to Get With The Guidelines parameters on patients who underwent IV thrombolysis for AIS. Hypothesis: Implementation of an institutional Stroke Program lowers door-to-needle time (DNT) and improves adherence to stroke quality measures in patients treated with IV thrombolysis. Methods: The study included all patients with AIS diagnosis treated with IV thrombolysis between January 2010 and May 2016. We then compared patients admitted before and after June 2014 (start of the Stroke Program). Results: A total of 56 patients were included, 30 (53.6%) were admitted preintervention and 26 (46.4%) postintervention. All of them were treated with IV thrombolysis. All time parameters related to quality of attention were shorter in patients after the Stroke Program started. DNT was 21 minutes shorter in the Stroke Program group (mean 65 vs 86 min, p<0.03), and the number of patients within the DNT time goal of 60 minutes was larger postintervention (44.8 vs 29.6%, (95%CI 0.76 - 2.6, p=0.24)]. Adherence to stroke quality measures was more common in the Stroke Program group. Patients included after the start of the stroke program had a higher NIHSS score upon discharge. The probability of a good outcome (mRS<3) upon discharge was higher in the Stroke Program group (61.1% vs 31.4%) [RR = 1.9 (95%CI 1.17 - 3.38)]. Conclusions: Implementation of a Stroke Care program diminished DNT significantly and improved adherence to stroke quality measures. This may result on better outcomes for AIS patients.

Abstract W P288: Using “Big Data” Analytics and Visualization for Quality Improvement in Stroke Care

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sara J Kavanagh ◽  
Benjamin Bray ◽  
Lizz Paley ◽  
James T Campbell ◽  
Emma Vestesson ◽  
...  
Keyword(s):  
Big Data ◽  
Real Time ◽  
Data Analytics ◽  
Good Practice ◽  
Big Data Analytics ◽  
Stroke Care ◽  
Care Quality ◽  
Stroke Survivors ◽  
The Public ◽  
Quality Reporting

Introduction: The Sentinel Stroke National Audit Programme (SSNAP) is the new national stroke register of England and Wales. It has been designed to harness the power of “Big Data” to produce near real-time data collection, analysis and reporting. Sophisticated data visualization is used to provide customized analytics for clinical teams, administrators, healthcare funders and stroke survivors and carers. Methods: A portfolio of cutting edge data visualisation outputs, including team level slidedecks, performance charts, dashboards , and interactive maps, was produced. Visualisations for patients and the public were co-designed with stroke survivors. Stakeholder feedback regarding accessibility and usefulness of the resources was sought via online polls. Results: Key SSNAP results are made accessible electronically every three months in a range of bespoke graphical formats. Individualised slidedecks and data summaries are produced for every hospital, funding group, and region to enable provider level performance and quality reporting and regional and national benchmarking. Dynamic maps enhance dissemination and use of results. Real time root cause analysis tools help teams identify areas of improvement. Feedback reports unprecedented utility of these resources for clinical teams, funders, regional and national health bodies, patients and the public in identifying areas of good practice and requiring improvements, highlighting variations, and driving change. Conclusion: SSNAP is a potential new model of healthcare quality measurement that uses recent developments in big data analytics and visualization to provide information on stroke care quality that is more useful to stakeholders. Similar approaches could be used in other healthcare settings and populations.

Abstract 331: Area Specific Differences for Quality of Care and Outcomes in Ischemic Stroke in China

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Meng Wang ◽  
Zi-Xiao Li ◽  
Chun-Juan Wang ◽  
Xin Yang ◽  
Yong-Jun Wang
Keyword(s):  
Ischemic Stroke ◽  
Quality Of Care ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Hospital Death ◽  
Central Regions ◽  
Stroke Center ◽  
Care Improvement ◽  
Evidence Based Care

Background: Former studies suggest differences in stroke care associated with race, age or gender. We sought to find whether such disparities existed in different areas in patients hospitalized with stroke among hospitals participating in the China Stroke Center Association. Methods: In-hospital mortality and 4 stroke performance measures among 660,225 patients admitted with ischemic stroke in the Eastern, Central and Western regions of China in the China Stroke Center Association between 2015 and 2019. Results: After adjustment for both demographics and diseases history variables, western patients had lower odds relative of receiving intravenous thrombolysis (Eastern: OR, 1.78; 95%CI, 1.72 to 1.84; Central: OR, 1.55; 95%CI, 1.50 to 1.60), early antithrombotics (Eastern: OR, 1.95; 95%CI, 1.90 to 1.99; Central: OR, 1.86; 95%CI, 1.81 to 1.90), dysphagia screening (Eastern: OR, 1.03; 95%CI, 1.01 to 1.04; Central: OR, 0.83; 95%CI, 0.81 to 0.84) and NIHSS (Eastern: OR, 1.18; 95%CI, 1.16 to 1.20; Central: OR, 1.50; 95%CI, 1.48 to 1.53). However, the in-hospital death was higher in eastern and central regions (Eastern: OR, 0.48; 95%CI, 0.43 to 0.54; Central: OR, 0.51; 95%CI, 0.45 to 0.57). Conclusions: Western patients with stroke received fewer evidence-based care processes than central or eastern patients. Quality of care improvement in stroke should be focused on the west. The high mortality of the east and central probably resulted in that better hospitals in these areas received more severe patients substantially.

scholarly journals Stroke Center Certification Is Associated With Improved Guideline Concordance

2019 ◽  
Vol 34 (6) ◽  
pp. 585-589
Author(s):  
Adam S. Jasne ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J. Moomaw ◽  
Matthew L. Flaherty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Epidemiologic Study ◽  
Stroke Care ◽  
Population Based ◽  
Patient Demographics ◽  
Certification Programs ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Measurement of quality of stroke care has become increasingly important, but data come mostly from programs in hospitals that choose to participate in certification programs, which may not be representative of the care provided in nonparticipating hospitals. The authors sought to determine differences in quality of care metric concordance for acute ischemic stroke among hospitals designated as a primary stroke center, comprehensive stroke center, and non-stroke center in a population-based epidemiologic study. Significant differences were found in both patient demographics and in concordance with guideline-based quality metrics. These differences may help inform quality improvement efforts across hospitals involved in certification as well as those that are not.

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