Quality improvement in acute ischemic stroke care in Taiwan: The breakthrough collaborative in stroke
Journal
PLoS ONE
Journal Volume
11
Journal Issue
8
Pages
e0160426
Date Issued
2016
Author(s)
Hsieh F.-I.
Chern C.-M.
Lee T.-H.
Liao H.-H.
Chang H.
Labresh K.A.
Lin H.-J.
Chiou H.-Y.
Chiu H.-C.
Lien L.-M.
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. ? 2016 Hsieh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Other Subjects
tissue plasminogen activator; Article; brain hemorrhage; brain ischemia; controlled study; health care planning; health care quality; human; major clinical study; practice guideline; prescription; quality control; Taiwan; total quality management; acute disease; brain ischemia; clinical trial; complication; cooperation; fibrinolytic therapy; health care quality; hospital; multicenter study; organization and management; patient care; problem based learning; protocol compliance; register; standards; statistics and numerical data; Stroke; total quality management; Acute Disease; Brain Ischemia; Cooperative Behavior; Guideline Adherence; Hospitals; Humans; Patient Care Team; Problem-Based Learning; Quality Improvement; Quality of Health Care; Registries; Stroke; Taiwan; Thrombolytic Therapy
Type
journal article