Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke.
Perception Versus Actual Performance in Timely Tissue Plasminogen Activation Administration in the Management of Acute Ischemic Stroke.
复制标题
及时组织纤溶酶原激活治疗急性缺血性中风的认知与实际表现。
DOI：
10.1161/jaha.114.001298
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发表时间：
2015
影响因子：
5.4
通讯作者：
Shah,BimalR
中科院分区：
文献类型：
--
作者：
Lin,CherylB;Cox,Margueritte;Olson,DaiWaiM;Britz,GavinW;Constable,Mark;Fonarow,GreggC;Schwamm,Lee;Peterson,EricD;Shah,BimalR
研究背景及时溶栓治疗可改善脑卒中预后。然而，美国医院满足静脉注射组织纤溶酶原激活剂（tPA）指南的能力仍然不理想。目前尚不清楚的是，医院是否准确地认识到他们的tPA率“门到针”（DTN）的时间在60分钟内，以及如何DTN率比较在不同hospital.Methods和ResultsDTN的性能被定义为接受tPA治疗的患者在60分钟内到达的百分比。电话调查从141家接受指南医院的工作人员那里获得，代表了顶级，中级和低级DTN性能。不到三分之一（29.1%）的员工准确地确定了他们的DTN性能。在中等和低绩效医院（n=92）中，56家临床试验机构（60.9%）高估了其绩效; 42%的中等绩效医院和85%的低绩效医院高估了其绩效。高估的研究中心的tPA给药年量往往较低（中位数8.4例患者[第25 - 75百分位数5.9 - 11.8] vs 10.2例患者[第25 - 75百分位数8.2 - 17.3]，P=0.047），接受tPA的合格患者百分比较小DTN ≤60 min的比例在接受治疗的患者中较小（10.6%vs16.6%，P =0.002）。我们的研究结果表明，需要定期提供比较供应商的性能率作为一个关键步骤，以提高急性中风护理的质量。
BackgroundTimely thrombolytic therapy can improve stroke outcomes. Nevertheless, the ability of US hospitals to meet guidelines for intravenous tissue plasminogen activator (tPA) remains suboptimal. What is unclear is whether hospitals accurately perceive their rate of tPA “door‐to‐needle” (DTN) time within 60 minutes and how DTN rates compare across different hospitals.Methods and ResultsDTN performance was defined by the percentage of treated patients who received tPA within 60 minutes of arrival. Telephone surveys were obtained from staff at 141 Get With The Guidelines hospitals, representingtop, middle, andlowDTN performance. Less than one‐third (29.1%) of staff accurately identified their DTN performance. Among middle‐ and low‐performing hospitals (n=92), 56 sites (60.9%) overestimated their performance; 42% of middle performers and 85% of low performers overestimated their performance. Sites that overestimated tended to have lower annual volumes of tPA administration (median 8.4 patients [25th to 75th percentile 5.9 to 11.8] versus 10.2 patients [25th to 75th percentile 8.2 to 17.3],P=0.047), smaller percentages of eligible patients receiving tPA (84.7% versus 89.8%,P=0.008), and smaller percentages of DTN ≤60 minutes among treated patients (10.6% versus 16.6%,P=0.002).ConclusionsHospitals often overestimate their ability to deliver timely tPA to treated patients. Our findings indicate the need to routinely provide comparative provider performance rates as a key step to improving the quality of acute stroke care.