Abstract 303: A Novel Multi-modal Approach to Stroke Care Quality Improvement and The Development of High-performing Stroke Care Teams

Abstract

Background: The clinical outcomes and quality of care in acute ischemic stroke (AIS) are time-dependent and influenced by the effectiveness and efficiency of the care delivery system. Much attention has been given to improving process and procedure; however, the structure and inter[[Unable to Display Character: ‐]]dependencies of the stroke care teams must be integrated into any acute stroke care quality improvement process. Objective: The objective of this study was to apply an innovative multi[[Unable to Display Character: ‐]]modal analytic approach that combines formal epidemiologic analysis, process evaluation and social network modeling of stroke care teams to describe and improve the critical system characteristics of high[[Unable to Display Character: ‐]]performing units in real[[Unable to Display Character: ‐]]world hospital systems. Methods: Characteristics of individual hospital units, as well as variation of treatment delivery, were analyzed and compared. A critical path analysis was created based on a widely adopted acute stroke care process model. Stroke care team structures and inter[[Unable to Display Character: ‐]] dependencies were mapped based on the responses to a survey and the responses were analyzed using open[[Unable to Display Character: ‐]]source network graphing software. Results: The care team networks were overlaid on to the corresponding process pathways to create a final synthesis of the process and team structure (example below). Critical path analysis combined with mapping of the individual stroke team network interactions demonstrated additional associations between the team structures and process/clinical outcomes. Opportunities for improvement in both process and personnel organization were identified and integrated into existing CQI efforts. Conclusion: Multi[[Unable to Display Character: ‐]]modal systems analysis incorporating both care process and stroke care team inter[[Unable to Display Character: ‐]]dependencies offers an enhanced approach to integrated quality improvement for acute stroke care.