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Published on: January 15, 2017
Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Zixiao Li1, Chunjuan Wang1, Xingquan Zhao1
1From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.).
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 (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 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.
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