Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke

作者：Chunjuan Wang, Hongqiu Gu, Lixia Zong, Xinmiao Zhang, Qi Zhou, Yong Jiang, Hao Li, Xia Meng, Xin Yang, Meng Wang, Xiaochuan Huo, Runqi Wangqin, Yuzhang Bei, Xiu-Hui Qi, Xiaoyun Liu, Shiqiang Hu, Zhimin Wang, Xingquan Zhao, Yilong Wang, Liping Liu, Xudong Ma, Louise Morgan, Ying Xian, Lee H. Schwamm, Yongjun Wang, Zixiao Li, IMPROVE Stroke Care in China investigators, Qingcheng Yang, Guangsheng Chen, Qianli Ma, Xiaobo Li, Jun Chen, Zhao Xiuli, Hongping Wang, Xiaoyuan Niu, Jianhua Xu, Lile Zhao, Zicheng Wang, Danqin Huang, Xiaoping Jin, Shengli Chen, Jianhua Li, Juming Yu, Ping Liu, Guozhong Li, Yanlei Hao, Guancheng Yang, Xiaoxin Huang, Chengfang Zhou, Junsu Yang, Jun Gu, Peng Sun, Zaiyu Guo, Guoping Ma, Guohua Chen, Mingshan Tang, Ning Wang, Lixia Chen, Juntao Li, Aiwu Li, Song Li, Minghua Cao, Jianqiang Guo, Youquan Ren, Tong Li, Lihong Zhang, Zhaoming Xie, Junlin Dong, Xiangfeng Kong, Hui Liang, Yan Zhang · 发表于：JAMA Network Open · 年份：2023 · DOI：10.1001/jamanetworkopen.2023.16465 · 被引用次数：14 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Neurological Disease Mechanisms and Treatments

Importance: Reperfusion therapy is the most effective treatment for acute ischemic stroke but remains underused in China. Objective: To evaluate the effect of a problem-oriented, culturally adapted, targeted quality improvement intervention on reperfusion therapy for patients with acute ischemic stroke in China. Design, Setting, and Participants: In this stepped-wedge cluster randomized clinical trial, patients from 16 secondary and 33 tertiary hospitals in China with acute ischemic stroke within 6 hours of symptom onset were consecutively recruited between July 1, 2018, and June 30, 2020. Interventions: Hospitals were randomly assigned to 1 of 3 sequences to receive the targeted quality improvement intervention (n = 5689), in which workflow reconstruction was promoted to reduce in-hospital reperfusion treatment delays, or usual care (n = 6443), in which conventional stroke care was left to the discretion of the stroke team. Main Outcomes and Measures: The primary outcome was the reperfusion therapy rate, a composite outcome of intravenous recombinant tissue plasminogen activator (IV rtPA) or endovascular thrombectomy (EVT) for eligible patients who arrived within 3.5 or 4.5 hours of symptom onset. Secondary outcomes were the IV rtPA administration rate among eligible patients who arrived within 3.5 hours of symptom onset, the EVT rate among eligible participants who arrived within 4.5 hours of symptom onset, the proportion of patients with door-to-needle time within 60 minut...