Abstract 136: A Cluster Randomized Trial of a Multifaceted Intervention to Improve Adherence to Evidence-Based Treatments in Acute Ischemic Stroke in China

Abstract

Background: There are considerable gaps in adherence to evidence-based stroke care in China. Our primary aim was to determine whether a multifaceted quality improvement (QI) intervention could improve adherence to the 9 evidence-based performance measures among Chinese patients with acute ischemic stroke (AIS). Methods: The Multifaceted Intervention to Improve AIS Care (GOLDEN BRIDGE-AIS) trial was a two-arm, multicenter, cluster-randomized, controlled trial. Patient hospitalized with AIS were included. Hospitals were randomized (1:1) to the intervention or a usual care control arm. The multifaceted QI intervention involved a clinical pathway, written care protocols, oversight by a quality coordinator, and a monitoring and feedback system of performance measures. The primary outcome was adherence to AIS evidence-based performance measures. Results: 4800 patients were enrolled from 40 hospitals, n=2400 intervention and n=2400 control with 12-month follow-up. Interventional hospital patients were more likely to receive acute and discharge treatments than those in the control hospitals (composite measure 88.2% vs 84.8%, adjusted OR, 1.38 [95% CI, 1.11-1.71], p value=0.003) (Table). Kaplan-Meier estimates showed a reduction in the secondary outcomes of 12-month new clinical vascular events in the intervention versus control group (HR 0.73, 95% CI, 0.61-0.87; p value<0.001) (Figure). Conclusion: Among patients with AIS treated in China, a multifaceted QI intervention improved the composite adherence to the evidence-based treatments as well as significantly reduced new vascular events. Trial Registration: clinicaltrials.gov Identifier: NCT02212912.