Li Zixiao, Wang Chunjuan, Zhao Xingquan, Liu Liping, Wang Chunxue, Li Hao, Shen Haipeng, Liang Li, Bettger Janet, Yang Qing, Wang David, Wang Anxin, Pan Yuesong, Jiang Yong, Yang Xiaomeng, Zhang Changqing, Fonarow Gregg C, Schwamm Lee H, Hu Bo, Peterson Eric D, Xian Ying, Wang Yilong, Wang Yongjun
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.).
Stroke. 2016 Nov;47(11):2843-2849. doi: 10.1161/STROKEAHA.116.014143. Epub 2016 Oct 6.
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.
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.
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.
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.
在中国，中风是主要的死亡原因之一。然而，过去十年中对指南推荐的缺血性中风性能指标的遵循情况一直不太理想。从那时起，中国开展了多项全国性的中风质量管理倡议。我们试图确定从那时起遵循情况是否有所改善。
数据来自中国国家中风登记处的两个阶段，其中包括2007年至2008年中国国家中风登记处第一阶段的131家医院（12173例急性缺血性中风患者），以及2012年至2013年中国国家中风登记处第二阶段的219家医院（19604例患者）。建立多元回归模型以评估两个研究时期在遵循性能指标方面的差异。
随着时间的推移，整体护理质量有所提高，这体现在2012年至2013年的综合评分为0.76，高于2007年至2008年的0.63。13项个体性能指标中有9项有所改善。然而，静脉溶栓治疗率和房颤抗凝率没有显著提高。多变量分析后，与较早数据相比，近期提供基于证据的性能指标的几率仍显著增加1.17倍（95%置信区间，1.14 - 1.21）。几率增加最显著的性能指标包括中风教育、吞咽困难筛查、戒烟和出院时的抗血栓治疗。
随着时间的推移，对中风性能指标的遵循情况有所增加，但仍有很大的进一步改进空间。在中国，应将持续的中风质量改进计划作为国家优先事项来制定。
