Did a quality improvement collaborative make stroke care better? A cluster randomized trial.

Area of Science:

• Neurology
• Public Health
• Healthcare Quality Improvement

Background:

• Stroke is a leading cause of death and disability.
• Variability in UK stroke care compliance is documented.
• The effectiveness of Quality Improvement Collaboratives (QICs) for stroke care reliability was previously unknown.

Purpose of the Study:

• To determine if a QIC, Stroke 90:10, could improve the reliability of stroke care processes.
• To compare compliance with care bundles in QIC-participating hospitals versus control hospitals.

Main Methods:

• A randomized controlled trial involving 24 NHS hospitals in Northwest England.
• Hospitals were assigned to either the Stroke 90:10 QIC (Breakthrough Series model) or a control group receiving standard care.
• Interrupted time series design and difference-in-difference analysis were used to assess changes in care bundle compliance.

Main Results:

• Hospitals in the QIC demonstrated modest improvements in compliance with the Early Hours Bundle (10.9% relative improvement) and the Rehabilitation Bundle (11.2% relative improvement).
• Data included 3,533 patients from intervention hospitals and 3,059 from control hospitals.
• Specific care processes showed varying sensitivity to the QIC intervention.

Conclusions:

• The QIC led to some improvements in stroke care but effects were modest.
• The overall impact of a Breakthrough Series QIC on stroke care quality requires further investigation.
• Certain aspects of stroke care may be more responsive to collaborative interventions than others.