Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
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DOI：
10.1161/strokeaha.116.014143
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发表时间：
2016-11-01
期刊：
影响因子：
8.3
通讯作者：
Wang, Yongjun
中科院分区：
文献类型：
--
作者：
Li, Zixiao;Wang, Chunjuan;Wang, Yongjun
背景和目的-脑卒中是中国人的主要死亡原因。然而，在过去的十年中，对指南推荐的缺血性卒中性能指标的遵守情况已被证明是次优的。从那时起，在中国开展了几项全国性的卒中质量管理举措。我们试图确定从那时起是否依从性得到了改善。方法数据来自中国国家卒中登记中心的2个阶段，其中包括131家医院2007年至2008年中国国家卒中登记研究第1期（12173例急性缺血性卒中患者）与219家医院2012年至2013年中国国家卒中登记研究II期（19604例患者）。多元回归模型的开发，以评估的差异，坚持性能测量之间的2研究periods.Results-The整体护理质量随着时间的推移有所改善，反映了较高的综合得分为0.76，在2012年至2013年与0.63，在2007年至2008年。13项个人绩效指标中有9项得到改善。然而，静脉溶栓治疗和抗凝治疗房颤的比率没有显著改善。多变量分析后，与旧数据相比，在最近的时间段内提供循证性能指标的几率仍然显著增加1.17倍（95%置信区间，1.14-1.21）。最显着增加的几率的性能指标包括中风教育，吞咽困难筛查，戒烟，并在discharge. Conclusions，坚持中风性能指标随着时间的推移而增加，但仍有显着的机会进一步改善。我国应将持续卒中质量改善项目作为国家重点项目来开展。
Background and Purpose-Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then.Methods-Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19604 patients) in China National Stroke Registries phase 2 from 2012 to 2013. Multiple regression models were developed to evaluate the difference in adherence to performance measure between the 2 study periods.Results-The overall quality of care has improved over time, as reflected by the higher composite score of 0.76 in 2012 to 2013 versus 0.63 in 2007 to 2008. Nine of 13 individual performance metrics improved. However, there were no significant improvements in the rates of intravenous thrombolytic therapy and anticoagulation for atrial fibrillation. After multivariate analysis, there remained a significant 1.17-fold (95% confidence interval, 1.14-1.21) increase in the odds of delivering evidence-based performance metrics in the more recent time periods versus older data. The performance metrics with the most significantly increased odds included stroke education, dysphagia screening, smoking cessation, and antithrombotics at discharge.Conclusions-Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China.