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Article: Effect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: A randomized clinical trial

TitleEffect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: A randomized clinical trial
Authors
Issue Date2018
PublisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl
Citation
JAMA, 2018, v. 320 n. 3, p. 245-254 How to Cite?
AbstractImportance In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited. Objective To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) in China. Design, Setting, and Participants A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016. Interventions Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback. Twenty hospitals participated in the stroke registry with usual care (control group; 2400 patients). Main Outcomes and Measures The primary outcome was hospital personnel adherence to 9 AIS performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to, and as all-or-none. Secondary outcomes included in-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months. Results Among 4800 patients with AIS enrolled from 40 hospitals and randomized (mean age, 65 years; women, 1757 [36.6%]), 3980 patients (82.9%) completed the 12-month follow-up of the trial. Patients in intervention group were more likely to receive performance measures than those in the control groups (composite measure, 88.2% vs 84.8%, respectively; absolute difference, 3.54% [95% CI, 0.68% to 6.40%], P = .02). The all-or-none measure did not significantly differ between the intervention and control groups (53.8% vs 47.8%, respectively; absolute difference, 6.69% [95% CI, −0.41% to 13.79%], P = .06). New clinical vascular events were significantly reduced in the intervention group compared with the control group at 3 months (3.9% vs 5.3%, respectively; difference, −2.03% [95% CI, −3.51% to −0.55%]; P = .007), 6 months (6.3% vs 7.8%, respectively; difference, −2.18% [95% CI, −4.0% to −0.35%]; P = .02) and 12 months (9.1% vs 11.8%, respectively; difference, −3.13% [95% CI, −5.28% to −0.97%]; P = .005). Conclusions and Relevance Among 40 hospitals in China, a multifaceted quality improvement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Further research is needed to understand the generalizability of these findings.
Persistent Identifierhttp://hdl.handle.net/10722/263830
ISSN
2017 Impact Factor: 47.661
2015 SCImago Journal Rankings: 6.440
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorWang, Y-
dc.contributor.authorLi, Z-
dc.contributor.authorZhao, X-
dc.contributor.authorWang, C-
dc.contributor.authorWang, X-
dc.contributor.authorWang, D-
dc.contributor.authorLiang, L-
dc.contributor.authorLiu, L-
dc.contributor.authorWang, C-
dc.contributor.authorLi, H-
dc.contributor.authorShen, H-
dc.contributor.authorBettger, J-
dc.contributor.authorPan, Y-
dc.contributor.authorJiang, Y-
dc.contributor.authorYang, X-
dc.contributor.authorZhang, C-
dc.contributor.authorHan, X-
dc.contributor.authorMeng, X-
dc.contributor.authorYang, X-
dc.contributor.authorKang, H-
dc.contributor.authorYuan, W-
dc.contributor.authorFonarow, GC-
dc.contributor.authorPeterson, ED-
dc.contributor.authorSchwamm, LH-
dc.contributor.authorXian, Y-
dc.contributor.authorWang, Y-
dc.date.accessioned2018-10-22T07:45:09Z-
dc.date.available2018-10-22T07:45:09Z-
dc.date.issued2018-
dc.identifier.citationJAMA, 2018, v. 320 n. 3, p. 245-254-
dc.identifier.issn0098-7484-
dc.identifier.urihttp://hdl.handle.net/10722/263830-
dc.description.abstractImportance In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited. Objective To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) in China. Design, Setting, and Participants A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016. Interventions Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback. Twenty hospitals participated in the stroke registry with usual care (control group; 2400 patients). Main Outcomes and Measures The primary outcome was hospital personnel adherence to 9 AIS performance measures, with co-primary outcomes of a composite of percentage of performance measures adhered to, and as all-or-none. Secondary outcomes included in-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months. Results Among 4800 patients with AIS enrolled from 40 hospitals and randomized (mean age, 65 years; women, 1757 [36.6%]), 3980 patients (82.9%) completed the 12-month follow-up of the trial. Patients in intervention group were more likely to receive performance measures than those in the control groups (composite measure, 88.2% vs 84.8%, respectively; absolute difference, 3.54% [95% CI, 0.68% to 6.40%], P = .02). The all-or-none measure did not significantly differ between the intervention and control groups (53.8% vs 47.8%, respectively; absolute difference, 6.69% [95% CI, −0.41% to 13.79%], P = .06). New clinical vascular events were significantly reduced in the intervention group compared with the control group at 3 months (3.9% vs 5.3%, respectively; difference, −2.03% [95% CI, −3.51% to −0.55%]; P = .007), 6 months (6.3% vs 7.8%, respectively; difference, −2.18% [95% CI, −4.0% to −0.35%]; P = .02) and 12 months (9.1% vs 11.8%, respectively; difference, −3.13% [95% CI, −5.28% to −0.97%]; P = .005). Conclusions and Relevance Among 40 hospitals in China, a multifaceted quality improvement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Further research is needed to understand the generalizability of these findings.-
dc.languageeng-
dc.publisherAmerican Medical Association. The Journal's web site is located at http://jama.ama-assn.org/index.dtl-
dc.relation.ispartofJAMA-
dc.titleEffect of a multifaceted quality improvement intervention on hospital personnel adherence to performance measures in patients with acute ischemic stroke in China: A randomized clinical trial-
dc.typeArticle-
dc.identifier.emailShen, H: haipeng@hku.hk-
dc.identifier.authorityShen, H=rp02082-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1001/jama.2018.8802-
dc.identifier.pmid29959443-
dc.identifier.scopuseid_2-s2.0-85050406827-
dc.identifier.hkuros295594-
dc.identifier.volume320-
dc.identifier.issue3-
dc.identifier.spage245-
dc.identifier.epage254-
dc.identifier.isiWOS:000438900300018-
dc.publisher.placeUnited States-

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