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.
dc.contributor.author | Wang, Yilong | |
dc.contributor.author | Li, Zixiao | |
dc.contributor.author | Zhao, Xingquan | |
dc.contributor.author | Wang, Chunjuan | |
dc.contributor.author | Wang, Xianwei | |
dc.contributor.author | Wang, David | |
dc.contributor.author | Liang, Li | |
dc.contributor.author | Liu, Liping | |
dc.contributor.author | Wang, Chunxue | |
dc.contributor.author | Li, Hao | |
dc.contributor.author | Shen, Haipeng | |
dc.contributor.author | Bettger, Janet | |
dc.contributor.author | Pan, Yuesong | |
dc.contributor.author | Jiang, Yong | |
dc.contributor.author | Yang, Xiaomeng | |
dc.contributor.author | Zhang, Changqing | |
dc.contributor.author | Han, Xiujie | |
dc.contributor.author | Meng, Xia | |
dc.contributor.author | Yang, Xin | |
dc.contributor.author | Kang, Hong | |
dc.contributor.author | Yuan, Weiqiang | |
dc.contributor.author | Fonarow, Gregg C | |
dc.contributor.author | Peterson, Eric D | |
dc.contributor.author | Schwamm, Lee H | |
dc.contributor.author | Xian, Ying | |
dc.contributor.author | Wang, Yongjun | |
dc.contributor.author | GOLDEN BRIDGE—AIS Investigators | |
dc.date.accessioned | 2020-10-27T17:49:36Z | |
dc.date.available | 2020-10-27T17:49:36Z | |
dc.date.issued | 2018-07 | |
dc.date.updated | 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 | |
dc.identifier.issn | 0098-7484 | |
dc.identifier.issn | 1538-3598 | |
dc.identifier.uri | ||
dc.language | eng | |
dc.publisher | American Medical Association (AMA) | |
dc.relation.ispartof | JAMA | |
dc.relation.isversionof | 10.1001/jama.2018.8802 | |
dc.subject | GOLDEN BRIDGE—AIS Investigators | |
dc.subject | Humans | |
dc.subject | Brain Ischemia | |
dc.subject | Hospital Mortality | |
dc.subject | Evidence-Based Medicine | |
dc.subject | Aged | |
dc.subject | Middle Aged | |
dc.subject | Personnel, Hospital | |
dc.subject | Hospitals, Public | |
dc.subject | Guideline Adherence | |
dc.subject | Outcome and Process Assessment (Health Care) | |
dc.subject | Quality Indicators, Health Care | |
dc.subject | China | |
dc.subject | Female | |
dc.subject | Male | |
dc.subject | Stroke | |
dc.subject | Secondary Prevention | |
dc.subject | 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. | |
dc.type | Journal article | |
duke.contributor.orcid | Bettger, Janet|0000-0001-9708-8413 | |
duke.contributor.orcid | Peterson, Eric D|0000-0002-5415-4721 | |
duke.contributor.orcid | Xian, Ying|0000-0002-1237-1162 | |
pubs.begin-page | 245 | |
pubs.end-page | 254 | |
pubs.issue | 3 | |
pubs.organisational-group | School of Medicine | |
pubs.organisational-group | Duke Clinical Research Institute | |
pubs.organisational-group | Medicine, Cardiology | |
pubs.organisational-group | Duke | |
pubs.organisational-group | Institutes and Centers | |
pubs.organisational-group | Medicine | |
pubs.organisational-group | Clinical Science Departments | |
pubs.organisational-group | Nursing | |
pubs.organisational-group | Duke Science & Society | |
pubs.organisational-group | Duke Global Health Institute | |
pubs.organisational-group | Orthopaedics | |
pubs.organisational-group | School of Nursing | |
pubs.organisational-group | Initiatives | |
pubs.organisational-group | Institutes and Provost's Academic Units | |
pubs.organisational-group | University Institutes and Centers | |
pubs.organisational-group | Neurology, Neurocritical Care | |
pubs.organisational-group | Medicine, Clinical Pharmacology | |
pubs.organisational-group | Neurology | |
pubs.publication-status | Published | |
pubs.volume | 320 |
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