Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial.

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Wang, Yilong

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Li, Zixiao

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Zhao, Xingquan

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Wang, Chunjuan

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Wang, Xianwei

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Wang, David

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Liang, Li

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Liu, Liping

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Wang, Chunxue

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Li, Hao

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Shen, Haipeng

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Bettger, Janet

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Pan, Yuesong

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Jiang, Yong

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Yang, Xiaomeng

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Zhang, Changqing

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Han, Xiujie

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Meng, Xia

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Yang, Xin

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Kang, Hong

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Yuan, Weiqiang

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Fonarow, Gregg C

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Peterson, Eric D

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Schwamm, Lee H

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Xian, Ying

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Wang, Yongjun

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GOLDEN BRIDGE—AIS Investigators

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2020-10-27T17:49:36Z

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2020-10-27T17:49:36Z

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2018-07

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2020-10-27T17:49:32Z

dc.description.abstract

In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited.To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) in China.A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016.Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback. Twenty hospitals participated in the stroke registry with usual care (control group; 2400 patients).The primary outcome was hospital personnel adherence to 9 AIS performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to, and as all-or-none. Secondary outcomes included in-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months.Among 4800 patients with AIS enrolled from 40 hospitals and randomized (mean age, 65 years; women, 1757 [36.6%]), 3980 patients (82.9%) completed the 12-month follow-up of the trial. Patients in intervention group were more likely to receive performance measures than those in the control groups (composite measure, 88.2% vs 84.8%, respectively; absolute difference, 3.54% [95% CI, 0.68% to 6.40%], P = .02). The all-or-none measure did not significantly differ between the intervention and control groups (53.8% vs 47.8%, respectively; absolute difference, 6.69% [95% CI, -0.41% to 13.79%], P = .06). New clinical vascular events were significantly reduced in the intervention group compared with the control group at 3 months (3.9% vs 5.3%, respectively; difference, -2.03% [95% CI, -3.51% to -0.55%]; P = .007), 6 months (6.3% vs 7.8%, respectively; difference, -2.18% [95% CI, -4.0% to -0.35%]; P = .02) and 12 months (9.1% vs 11.8%, respectively; difference, -3.13% [95% CI, -5.28% to -0.97%]; P = .005).Among 40 hospitals in China, a multifaceted quality improvement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Further research is needed to understand the generalizability of these findings.ClinicalTrials.gov Identifier: NCT02212912.

dc.identifier

2687118

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0098-7484

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1538-3598

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https://hdl.handle.net/10161/21640

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eng

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American Medical Association (AMA)

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JAMA

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10.1001/jama.2018.8802

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GOLDEN BRIDGE—AIS Investigators

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Humans

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Brain Ischemia

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Hospital Mortality

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Evidence-Based Medicine

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Aged

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Middle Aged

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Personnel, Hospital

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Hospitals, Public

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Guideline Adherence

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Outcome and Process Assessment (Health Care)

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Quality Indicators, Health Care

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China

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Female

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Male

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Stroke

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Secondary Prevention

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Quality Improvement

dc.title

Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial.

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Journal article

duke.contributor.orcid

Bettger, Janet|0000-0001-9708-8413

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Peterson, Eric D|0000-0002-5415-4721

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Xian, Ying|0000-0002-1237-1162

pubs.begin-page

245

pubs.end-page

254

pubs.issue

3

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School of Medicine

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Duke Clinical Research Institute

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Medicine, Cardiology

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Duke

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Institutes and Centers

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Medicine

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Clinical Science Departments

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Nursing

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Duke Science & Society

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Duke Global Health Institute

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Orthopaedics

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School of Nursing

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Initiatives

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Neurology, Neurocritical Care

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Medicine, Clinical Pharmacology

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Neurology

pubs.publication-status

Published

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320

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