Compliance with acute stroke care quality measures in hospitals with and without primary stroke center certification: the North Carolina Stroke Care Collaborative.
Compliance with acute stroke care quality measures in hospitals with and without primary stroke center certification: the North Carolina Stroke Care Collaborative.
复制标题
遵守有或没有初级中风中心认证的医院的急性中风护理质量措施：北卡罗来纳州中风护理合作组织。
DOI：
10.1161/jaha.113.000423
复制
发表时间：
2014-04-10
影响因子：
5.4
通讯作者：
investigators of the Registry of the North Carolina Stroke Care Collaborative
中科院分区：
文献类型：
--
作者：
Johnson AM;Goldstein LB;Bennett P;O'Brien EC;Rosamond WD;investigators of the Registry of the North Carolina Stroke Care Collaborative
有组织的中风护理与改善预后相关。联合委员会认证的初级卒中中心（PSCs）与非PSCs的急性卒中护理质量随时间变化的差异数据有限。我们比较了2005年1月至2010年2月参加北卡罗来纳卒中护理合作登记的PSCs和非PSCs对联合委员会10项急性卒中护理绩效指标和无缺陷护理的依从性。我们纳入了来自47家医院的29654例病例，其中10家为退伍军人服务中心，8家为认证做准备，29家为非退伍军人服务中心，占北卡罗莱纳州非退伍军人事务急症护理医院的43%。使用非PSC参照物，使用逻辑回归和考虑医院内病例聚类的广义估计方程计算优势比和95% ci。时间趋势用简单的线性回归图形化表示。2005-2010年，所有三组的所有措施的绩效测量依从性都有所增加，但抗血栓药物的出院率一直很高。与非PSCs相比，PSCs和准备认证的医院在除2项绩效指标外的所有指标上都具有更好的依从性（各P<0.01）。在准备认证的医院中，提供无缺陷护理的比例最高（52.8%），其次是psc（45.0%）和非psc（21.9%）。2005年至2010年间，与非psc相比，psc和准备认证的医院在提供无缺陷护理方面的平均年增长率更高（P分别=0.01和0.04）。PSC认证与北卡罗莱纳州中风护理质量的全面改善有关；然而，仍有改进的余地。
Organized stroke care is associated with improved outcomes. Data are limited on differences in changes in the quality of acute stroke care at The Joint Commission–certified Primary Stroke Centers (PSCs) versus non‐PSCs over time. We compared compliance with the Joint Commission's 10 acute stroke care performance measures and defect‐free care in PSCs and non‐PSCs participating in the Registry of the North Carolina Stroke Care Collaborative from January 2005 through February 2010. We included 29 654 cases presenting at 47 hospitals—10 PSCs, 8 preparing for certification, and 29 non‐PSCs—representing 43% of North Carolina's non–Veterans Affairs, acute care hospitals. Using a non‐PSC referent, odds ratios and 95% CIs were calculated using logistic regression and generalized estimating equations accounting for clustering of cases within hospitals. Time trends were presented graphically using simple linear regression. Performance measure compliance increased for all measures for all 3 groups in 2005–2010, with the exception of discharge on antithrombotics, which remained consistently high. PSCs and hospitals preparing for certification had better compliance with all but 2 performance measures compared with non‐PSCs (each P<0.01). Defect‐free care was delivered most consistently at hospitals preparing for certification (52.8%), followed by PSCs (45.0%) and non‐PSCs (21.9%). Between 2005 and 2010, PSCs and hospitals preparing for certification had a higher average annual percent increase in the provision of defect‐free care (P=0.01 and 0.04, respectively) compared with non‐PSCs. PSC certification is associated with an overall improvement in the quality of stroke care in North Carolina; however, room for improvement remains.