TY - JOUR
T1 - Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes
T2 - A prospective quality improvement project
AU - Xu, Jiawen
AU - Xie, Yanan
AU - Fang, Kun
AU - Wang, Xin
AU - Chen, Shengdi
AU - Liu, Xueyuan
AU - Zhao, Yuwu
AU - Guan, Yangtai
AU - Cai, Dingfang
AU - Li, Gang
AU - Liu, Jianmin
AU - Liu, Jian Ren
AU - Zhuang, Jianhua
AU - Xian, Ying
AU - Shen, Haipeng
AU - Li, Hao
AU - Wang, David Z.
AU - Campbell, Bruce C.V.
AU - Parsons, Mark W.
AU - Dong, Yi
AU - Dong, Qiang
N1 - Publisher Copyright:
© 2022 World Stroke Organization.
PY - 2023/6
Y1 - 2023/6
N2 - Background: In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge. Aim: The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome. Methods: The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality. Results: The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015–2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference –1.08, 95% CI = [–1.18, –0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018–2020. Conclusion: The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT02735226.
AB - Background: In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge. Aim: The aim of the study was to determine whether the intervention by Shanghai Stroke Service System (4S) has helped improve adherence to stroke care guidelines and patient outcome. Methods: The 4S is a regional stroke network with real-time data extraction among its 61 stroke centers in Shanghai. A total of 11 key performance indicators (KPIs) were evaluated. The primary outcomes were a composite measure and an all-or-none measure of adherence to 11 KPIs. The secondary outcomes were length of hospital stay and in-hospital mortality. Results: The study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men) with acute ischemic stroke hospitalized within 7 days of onset in Shanghai from January 2015 to December 2020. More patients received guideline recommended care between 2018 and 2020 than those between 2015 and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%, 95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI = [2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001 for all comparisons). Compared with 2015–2017, hospital length of stay was shorter (10.95 vs 11.90 days; absolute difference –1.08, 95% CI = [–1.18, –0.99], p < 0.001), and in-hospital mortality was significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98], p = 0.01) in 2018–2020. Conclusion: The 4S intervention was associated with increased adherence to the stroke care guidelines, which further translated to improved clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT02735226.
KW - Ischemic stroke
KW - acute stroke therapy
KW - hospital performance
KW - quality care
KW - quality improvement
KW - stroke
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U2 - 10.1177/17474930221125993
DO - 10.1177/17474930221125993
M3 - Article
C2 - 36082948
AN - SCOPUS:85148436323
SN - 1747-4930
VL - 18
SP - 599
EP - 606
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 5
ER -