The quality disparity of stroke care over time: An analysis based on the national dataset from 2011 to 2017

Abstract

Background: Hospital adherence to evidence-based stroke care is variable and changes over time. We take full account of these variations and determined indicators which could reduce adverse outcomes and narrow inter-hospital variation in stroke patients under the current protocol of clinical treatment for stroke. Methods: We analyzed data from 123259 patients diagnosed with acute ischemic stroke (AIS) who were treated at 109 large tertiary hospitals from January 2011 to May 2017. Hospitals were divided into subgroups according to the time trend of hospital process composite performance (HPCP, that were calculated by the method of opportunity-based score on patient-level) estimated by the Group Based Model. We analyzed the influence of hospital subgroups on the patient outcomes using a multi-level model and explored the quality indicators (QIs) that led to variation. Results: The HPCP trends for stroke indicators of 109 hospitals over 7 years were divided into two groups (Group 1, low-HPCP; Group 2, high-HPCP). Patients in Group 2 tended to have a higher rate of independence (modified Rankin Scale≤2). The multi-level model showed that there was a statistically significant difference in the utilization rate between the two groups, which mainly focused on the emergency examination and function evaluation indicators. Conclusions: Variation in the quality of stroke care exists across hospitals. We found that QIs related to emergency examination and functional assessment were the main factors in different trends of stroke HPCP over time and identifying hospital care differences, suggesting that quality improvement in stroke care could prioritize these QIs.

Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours

“…Services for acute stroke treatment and prevention vary widely with many LMICs suffering from less adequate provision. 8–10 In this issue, we publish a detailed analysis by the Global Stroke Statistics team of the availability of reperfusion services. 11 They performed a systematic review of published articles as well as obtained data from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and PRE-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources.…”

Stroke in China

“…A second related article, also in this month’s issue, looks at the quality of stroke care in China between 2011 and 2017. Li and colleagues 2 analyzed data from 123,259 patients diagnosed with acute ischemic stroke who were treated at 109 large tertiary hospitals in China. Twelve stroke treatment indicators were selected to calculate a process performance score.…”

Stroke subtypes and outcomes in China, common clinical conundrums in stroke management, and pediatric stroke

“…Important avenues to reduce stroke burden in China include improving both risk factor prevention and acute stroke care, which was found to vary widely across China. 4 In this issue of the International Journal of Stroke ( IJS ), Gu et al 5 investigated both risk factors and their management, and in-hospital care, in China to determine whether they differed in women from men, to see if a more tailored treatment approach is required. They studied 26,900 IS admissions from 2005 to 2015 from the China PROGRESS database, a nationally representative cohort.…”