Abstract
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.
Highlights
It has been estimated that 16 million people suffer a stroke each year worldwide, and that 5.7 million will die as a result; around half of stroke survivors will suffer permanent disability [1]
The present study showed that quality of acute stroke care can be improved significantly after a well-organized, multi-center stroke quality improvement activity
The campaign activity described in this study was conducted through the Breakthrough Series (BTS) model introduced by the Institute for Healthcare Improvement in 1994 [23,24]
Summary
It has been estimated that 16 million people suffer a stroke each year worldwide, and that 5.7 million will die as a result; around half of stroke survivors will suffer permanent disability [1]. Many evidence-based stroke care guidelines have been updated in accordance with these considerations to successfully guide clinical practice procedures for stroke or transient ischemic attack [4,5,6,7,8]. With an adherence rate to evidence-based care of only 55% [9], a significant gap still exists between recommended guidelines and actual clinical practice. Adherence to evidence-based guidelines for treatment of stroke or transient ischemic attack is often suboptimal [10,11], and the availability of published recommended clinical guidelines is not in itself sufficient for successful management. Strategies that incorporate educational programs, as well as quality surveys on the implementation of the guidelines in clinical practice, are needed to improve stroke care quality [12]
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