Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

被引：26

作者：

Hsieh, Fang-I ^{[1
]}

Jeng, Jiann-Shing ^{[2
,3
]}

Chern, Chang-Ming ^{[4
]}

Lee, Tsong-Hai ^{[5
,6
]}

Tang, Sung-Chun ^{[2
,3
]}

Tsai, Li-Kai ^{[2
,3
]}

Liao, Hsun-Hsiang ^{[7
]}

Chang, Hang ^{[7
]}

LaBresh, Kenneth A. ^{[8
]}

Lin, Hung-Jung ^{[7
,9
,10
]}

Chiou, Hung-Yi ^{[1
]}

Chiu, Hou-Chang ^{[11
,12
]}

Lien, Li-Ming ^{[11
,13
]}

机构：

[1] Taipei Med Univ, Sch Publ Hlth, Taipei, Taiwan

[2] Natl Taiwan Univ Hosp, Stroke Ctr, Taipei, Taiwan

[3] Natl Taiwan Univ Hosp, Dept Neurol, Taipei, Taiwan

[4] Taipei Vet Gen Hosp, Neurol Inst, Taipei, Taiwan

[5] Chang Gung Univ, Chang Gung Mem Hosp, Dept Neurol, Linkou, Taiwan

[6] Chang Gung Univ, Coll Med, Linkou, Taiwan

[7] Taiwan Joint Commiss Hosp Accreditat, Taipei, Taiwan

[8] RTI Int, Waltham, MA USA

[9] Chi Mei Med Ctr, Dept Emergency Med, Tainan, Taiwan

[10] Southern Taiwan Univ Sci & Technol, Dept Biotechnol, Tainan, Taiwan

[11] Shin Kong Wu Ho Su Mem Hosp, Dept Neurol, 95 Wen Chang Rd, Taipei, Taiwan

[12] Fu Jen Catholic Univ, Coll Med, Taipei, Taiwan

[13] Taipei Med Univ, Sch Med, Coll Med, Taipei, Taiwan

来源：

PLOS ONE | 2016年 / 11卷 / 08期

关键词：

RANDOMIZED CONTROLLED-TRIAL; GUIDELINES-STROKE; HEALTH-CARE; PERFORMANCE-MEASURES; ATRIAL-FIBRILLATION; OF-CARE; ATTACK; ASSOCIATION; MANAGEMENT; RISK;

D O I：

10.1371/journal.pone.0160426

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time <= 60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p< 0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.

引用

页数：12