背景:在中国,卒中护理质量的差异仍然存在,实施质量改进仍是一项挑战.
目的:确定上海卒中服务系统(4S)的干预措施是否有助于提高对卒中护理指南的依从性和患者预后。
方法:4S是一个区域性卒中网络,在上海的61个卒中中心中进行实时数据提取。共评估了11项关键绩效指标(KPI)。主要结果是对11个KPI的依从性的综合测量和全无测量。次要结果是住院时间和住院死亡率。
结果:该研究纳入了92,395名患者(平均年龄69.0±12.5岁,65.2%的男性)在2015年1月至2020年12月在上海发病7天内住院的急性缺血性中风。与2015-2017年相比,2018-2020年期间接受指南推荐护理的患者更多(综合测量为87.1%vs83.6%;绝对差异2.9%,95CI[2.7%至3.2%],P<0.001;全或无测量49.2%vs44.8%患者;绝对差异3.5%,95CI[2.7%至4.2%],P<0.001)。对单个KPI的进一步分析显示6个KPI的绝对增加范围为3.4%至8.9%(所有比较P<0.001)。与2015-2017年相比,住院时间更短(10.95vs11.90天;绝对差异-1.08,95CI[-1.18to-0.99],P<0.001),2018-2020年住院死亡率显着降低(RR0.88,95%CI[0.79-0.98];P=0.01)。
结论:4S干预与卒中护理指南的依从性增加相关,这进一步转化为改善的临床结果。
背景:ClinicalTrials.gov标识符:NCT02735226。
In
China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge.
The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome.
The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality.
The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015-2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference -1.08, 95% CI = [-1.18, -0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018-2020.
The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes.
ClinicalTrials.gov identifier: NCT02735226.