Stroke care quality in China: Substantial improvement, and a huge challenge and opportunity

Abstract

Stroke is The first two authors contributed equally. the leading cause of death and adult disability in China. Although evidence-based clinical interventions have been identified to improve care and outcomes in stroke, significant gaps still exist between guideline recommendations and clinical practice in China. Regional and national stroke registries have been used to assess the benchmark of stroke care quality, provide feedback on compliance with evidence-based performance measures to health care providers, and continuously improve stroke care quality without increasing additional medical costs in the past several decades worldwide. In China, stroke care has become a national priority. A series of stroke care quality assessment and improvement actions was initiated by the Ministry of Health to increase the detection of high-risk populations with stroke, rate of adherence to evidence-based process performance measures of stroke care, and stroke care organization development, aiming to decrease the burden of stroke. China National Stroke Registries have been started in 2007, and they are conducted every 3 to 5 years. A carotid disease screen and intervention project for communities was initiated in 2009. The Chinese Stroke Association, founded in 2015, launched the Chinese Stroke Center Alliance to increase the stroke center design in the near future. In this article, we described these stroke care actions and progression, summarized the benchmark and improvement of stroke care quality, and outlined the future plans in China.

Association of Lp‐PLA2 G994T gene polymorphism with risk of ischemic stroke in Chinese population

“…It is now estimated that stroke is the second leading cause of death and a major cause of serious disability for adults in the world . In China, the largest developing country with 1.38 billion people, stroke has been the leading cause of death in recent years, with approximately 1.6 million stroke deaths per year, or 157 stroke deaths per 100,000 deaths . Stroke is generally classified into ischemic stroke and hemorrhagic stroke .…”

Positive impact of the participation in the ENCHANTED trial in reducing Door-to-Needle Time

“…However, there is still a large gap between the DNT in China (mean DNT 97.5 min, which is consistent with some previous observational studies in China) and the quality performance DNT of <60 min recommended in international guidelines 8 – 11 . Although various quality improvement efforts have been undertaken in China in the last decade, resulting in dramatic improvements in acute stroke care, there remains significant gaps between guideline recommendations and clinical practice in this country 9 . The Target Stroke Initiative, launched by the American Heart Association and American Stroke Association in 2011, was successful at improving the timeliness of rtPA administration for AIS on a national scale in the United States 10 , 12 , 13 .…”

China’s response to the rising stroke burden

“… 21 Improvement in the quality of stroke care has become a national priority, and coordinated actions have been taken since 2000. 22 The overall quality of secondary prevention of stroke substantially improved from 2007 to 2012. 21 However, no significant improvement was seen in anticoagulation rates for atrial fibrillation (19.7% in 2007-08 versus 21% in 2012-13).…”

“… 14 23 The Chinese government sponsored a series of large scale regional and nationwide studies ( box 2 ) to identify the gaps between the adherence to guideline recommended therapy and clinical practice and to design and evaluate intervention tools to improve the quality of stroke care and patients’ outcomes. 21 22 24 …”