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Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project.

Authors :
Xu, Jiawen
Xie, Yanan
Fang, Kun
Wang, Xin
Chen, Shengdi
Liu, Xueyuan
Zhao, Yuwu
Guan, Yangtai
Cai, Dingfang
Li, Gang
Liu, Jianmin
Liu, JianRen
Zhuang, Jianhua
Xian, Ying
Shen, Haipeng
Li, Hao
Wang, David Z
Campbell, Bruce CV
Parsons, Mark W
Dong, Yi
Source :
International Journal of Stroke; Jun2023, Vol. 18 Issue 5, p599-606, 8p
Publication Year :
2023

Abstract

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. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17474930
Volume :
18
Issue :
5
Database :
Complementary Index
Journal :
International Journal of Stroke
Publication Type :
Academic Journal
Accession number :
163805959
Full Text :
https://doi.org/10.1177/17474930221125993