Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Zixiao Li; Chunjuan Wang; Xingquan Zhao; Liping Liu; Chunxue Wang; Hao Li; Haipeng Shen; Li Liang; Janet Bettger; Qing Yang; David Wang; Anxin Wang; Yuesong Pan; Yong Jiang; Xiaomeng Yang; Changqing Zhang; Gregg C Fonarow; Lee H Schwamm; Bo Hu; Eric D Peterson; Ying Xian; Yilong Wang; Yongjun Wang; China National Stroke Registries

doi:10.1161/STROKEAHA.116.014143

Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China

Stroke. 2016 Nov;47(11):2843-2849. doi: 10.1161/STROKEAHA.116.014143. Epub 2016 Oct 6.

Authors

Zixiao Li¹, Chunjuan Wang¹, Xingquan Zhao¹, Liping Liu¹, Chunxue Wang¹, Hao Li¹, Haipeng Shen¹, Li Liang¹, Janet Bettger¹, Qing Yang¹, David Wang¹, Anxin Wang¹, Yuesong Pan¹, Yong Jiang¹, Xiaomeng Yang¹, Changqing Zhang¹, Gregg C Fonarow¹, Lee H Schwamm¹, Bo Hu¹, Eric D Peterson¹, Ying Xian¹, Yilong Wang², Yongjun Wang²; China National Stroke Registries

Affiliations

¹ From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.).
² From the Division of Vascular Neurology, Department of Neurology (Z.L., X.Z., C.Z., Yongjun Wang), Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology (Z.L., Chunjuan Wang, H.L., A.W., Y.P., Y.J., X.Y., Yilong Wang), Neurointensive Care Unit, Department of Neurology (L.L.), and Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology (Chunxue Wang), Beijing TianTan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing (Yilong Wang, Yongjun Wang); Center of Stroke, Beijing Institute for Brain Disorders, China (Z.L., X.Z.); Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Chunjuan Wang); Department of Statistics and Operations Research, University of North Carolina at Chapel Hill (H.S.); Duke Clinical Research Institute (J.B., E.D.P., Y.X.) and Duke University School of Nursing (J.B., Q.Y.), Duke University, Durham, NC; INI Stroke Network, OSF Healthcare System, University of Illinois College of Medicine, Peoria (D.W.); Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center (G.C.F.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and Department of Quantitative Health Sciences, Cleveland Clinic, OH (B.H.). [email protected] [email protected].

PMID: 27758941
DOI: 10.1161/STROKEAHA.116.014143

Abstract

Background and purpose: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then.

Methods: Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013. Multiple regression models were developed to evaluate the difference in adherence to performance measure between the 2 study periods.

Results: The overall quality of care has improved over time, as reflected by the higher composite score of 0.76 in 2012 to 2013 versus 0.63 in 2007 to 2008. Nine of 13 individual performance metrics improved. However, there were no significant improvements in the rates of intravenous thrombolytic therapy and anticoagulation for atrial fibrillation. After multivariate analysis, there remained a significant 1.17-fold (95% confidence interval, 1.14-1.21) increase in the odds of delivering evidence-based performance metrics in the more recent time periods versus older data. The performance metrics with the most significantly increased odds included stroke education, dysphagia screening, smoking cessation, and antithrombotics at discharge.

Conclusions: Adherence to stroke performance metrics has increased over time, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China.

Keywords: China; hospitals; quality improvement; registries; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
China
Female
Guideline Adherence / statistics & numerical data*
Humans
Male
Middle Aged
Quality of Health Care / statistics & numerical data*
Registries / statistics & numerical data*
Stroke / therapy*