Rahiman Abdul, Saver Jeffrey L, Porter Verna, Buxton William, McNair Norma, Razinia Tannaz, Ovbiagele Bruce
Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California 90095, USA.
J Stroke Cerebrovasc Dis. 2008 Jan-Feb;17(1):5-8. doi: 10.1016/j.jstrokecerebrovasdis.2007.09.004.
Although various in-hospital stroke quality improvement programs have been associated with high treatment rates at hospital discharge, there are few data on the impact of these programs on clinical outcomes. We evaluated the impact of the PROTECT (Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment) program on short-term vascular risk.
Prospective data collected after discharge for ischemic stroke or transient ischemic attack caused by presumed atherosclerotic mechanism from a PROTECT intervention hospital and a comparison community hospital, which used conventional care, were compared. The 3-month follow-up clinical outcome data were then evaluated and differences in outcome frequency data between the two hospital groups were analyzed using Fisher's exact test. Covariate adjusted comparisons of percent with a vascular event was computed via logistic regression methods.
A total of 224 patients met study criteria: 126 patients at a PROTECT hospital and 98 patients at a comparator hospital. The 3-month postdischarge data were available for 78 patients at PROTECT hospital versus 65 control patients. Patients at a PROTECT hospital were more likely to be younger, be current smokers, and not have a history of atrial fibrillation. At 3 months, there was a covariate-adjusted difference in the intervention-hospital group versus the control-hospital group with regard to the incidence of a vascular event (transient ischemic attack, stroke, or myocardial infarction), 8.4% versus 22% (P = .036).
Compared with conventional care, PROTECT was associated with better 3-month vascular outcomes after stroke hospitalization. Further study is needed to confirm the potential favorable impact of stroke quality improvement programs on clinical outcomes.
尽管各种院内卒中质量改进项目与出院时的高治疗率相关，但关于这些项目对临床结局影响的数据却很少。我们评估了PROTECT（通过协调治疗预防血栓栓塞事件复发）项目对短期血管风险的影响。
比较了在一家采用常规治疗的对照社区医院以及一家PROTECT干预医院，对因推测为动脉粥样硬化机制导致的缺血性卒中或短暂性脑缺血发作出院后收集的前瞻性数据。然后评估3个月随访的临床结局数据，并使用Fisher精确检验分析两家医院组之间结局频率数据的差异。通过逻辑回归方法计算血管事件发生率的协变量调整比较。
共有224例患者符合研究标准：PROTECT医院126例患者，对照医院98例患者。PROTECT医院78例患者与对照医院65例患者可获得出院后3个月的数据。PROTECT医院的患者更可能较年轻、为当前吸烟者且无房颤病史。3个月时，干预医院组与对照医院组在血管事件（短暂性脑缺血发作、卒中或心肌梗死）发生率方面存在协变量调整差异，分别为8.4%和22%（P = 0.036）。
与常规治疗相比，PROTECT与卒中住院后3个月更好的血管结局相关。需要进一步研究以证实卒中质量改进项目对临床结局的潜在有利影响。
