A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators

Area of Science:

• Healthcare Quality Improvement
• Stroke Care Management
• Clinical Interventions

Background:

• Quality indicator feedback is known to enhance stroke care.
• This study evaluated the impact of quality improvement (QI) training combined with feedback versus feedback alone on inpatient stroke indicators.

Purpose of the Study:

• To determine if QI training plus indicator feedback is more effective than feedback alone in improving deep vein thrombosis (DVT) prophylaxis and dysphagia screening in stroke patients.
• To assess the sustained impact of QI interventions on specific stroke care metrics.

Main Methods:

• A cluster-randomised trial involving hospitals comparing QI training plus feedback to feedback alone.
• Intervention sites received collaborative training, external facilitation, and feedback; control sites received only feedback.
• Mixed-effect logistic models analyzed DVT prophylaxis and dysphagia screening rates pre-, during, and post-intervention.

Main Results:

• QI training was associated with a significant early improvement in DVT prophylaxis (OR 4.90, p<0.001) but this effect diminished post-intervention.
• Dysphagia screening improved similarly in both groups during the active phase, with greater improvement in control sites post-intervention (OR 0.67, p=0.04).
• Logistic models indicated a positive association of the intervention with DVT performance during active implementation and a negative association with dysphagia performance post-implementation.

Conclusions:

• Quality improvement training demonstrated an initial benefit for DVT prophylaxis but lacked sustained effects.
• The impact of QI training varied by indicator, showing no lasting improvement for dysphagia screening.
• External QI programs may offer rapid but potentially transient improvements in healthcare performance.