初级卒中中心认证机构对急性缺血性卒中护理质量和结局的影响差异。

Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization.

作者信息

Man Shumei, Cox Margueritte, Patel Puja, Smith Eric E, Reeves Mathew J, Saver Jeffrey L, Bhatt Deepak L, Xian Ying, Schwamm Lee H, Fonarow Gregg C

机构信息

From Department of Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH (S.M.); the Duke Clinical Research Center, Durham, NC (M.C., Y.X.); Department of Advocacy and Quality, American Heart Association, Dallas, TX (P.P.); Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Division of Neurology, University of California, Los Angeles (J.L.S.); Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Harvard University, Boston, MA (D.L.B.); Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Division of Neurology, Massachusetts General Hospital, Boston (L.H.S.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).

出版信息

Stroke. 2017 Feb;48(2):412-419. doi: 10.1161/STROKEAHA.116.014426. Epub 2016 Dec 22.

DOI:10.1161/STROKEAHA.116.014426

PMID:28008094

Abstract

BACKGROUND AND PURPOSE

Primary stroke center (PSC) certification was established to identify hospitals providing evidence-based care for stroke patients. The numbers of PSCs certified by Joint Commission (JC), Healthcare Facilities Accreditation Program, Det Norske Veritas, and State-based agencies have significantly increased in the past decade. This study aimed to evaluate whether PSCs certified by different organizations have similar quality of care and in-hospital outcomes.

METHODS

The study population consisted of acute ischemic stroke patients who were admitted to PSCs participating in Get With The Guidelines-Stroke between January 1, 2010, and December 31, 2012. Measures of care quality and outcomes were compared among the 4 different PSC certifications.

RESULTS

A total of 477 297 acute ischemic stroke admissions were identified from 977 certified PSCs (73.8% JC, 3.7% Det Norske Veritas, 1.2% Healthcare Facilities Accreditation Program, and 21.3% State-based). Composite care quality was generally similar among the 4 groups of hospitals, although State-based PSCs underperformed JC PSCs in a few key measures, including intravenous tissue-type plasminogen activator use. The rates of tissue-type plasminogen activator use were higher in JC and Det Norske Veritas (9.0% and 9.8%) and lower in State and Healthcare Facilities Accreditation Program certified hospitals (7.1% and 5.9%) (P<0.0001). Door-to-needle times were significantly longer in Healthcare Facilities Accreditation Program hospitals. State PSCs had higher in-hospital risk-adjusted mortality (odds ratio 1.23, 95% confidence intervals 1.07-1.41) compared with JC PSCs.

CONCLUSIONS

Among Get With The Guidelines-Stroke hospitals with PSC certification, acute ischemic stroke quality of care and outcomes may differ according to which organization provided certification. These findings may have important implications for further improving systems of care.

摘要

背景与目的

设立初级卒中中心（PSC）认证是为了识别为卒中患者提供循证治疗的医院。在过去十年中，经联合委员会（JC）、医疗保健机构认证计划、挪威船级社以及各州相关机构认证的初级卒中中心数量显著增加。本研究旨在评估不同组织认证的初级卒中中心是否具有相似的医疗质量和院内治疗结果。

方法

研究对象为2010年1月1日至2012年12月31日期间入住参与“遵循卒中治疗指南”项目的初级卒中中心的急性缺血性卒中患者。对4种不同初级卒中中心认证的医疗质量和治疗结果指标进行了比较。

结果

从977家认证的初级卒中中心共识别出477297例急性缺血性卒中住院病例（73.8%经联合委员会认证，3.7%经挪威船级社认证，1.2%经医疗保健机构认证计划认证，21.3%经各州相关机构认证）。4组医院的综合医疗质量总体相似，不过在一些关键指标上，各州相关机构认证的初级卒中中心表现不如联合委员会认证的初级卒中中心，包括静脉注射组织型纤溶酶原激活剂的使用。联合委员会和挪威船级社认证的医院组织型纤溶酶原激活剂的使用率较高（分别为9.0%和9.8%），而各州相关机构和医疗保健机构认证计划认证的医院使用率较低（分别为7.1%和5.9%）（P<0.0001）。医疗保健机构认证计划认证的医院从入院到用药的时间显著更长。与联合委员会认证的初级卒中中心相比，各州相关机构认证的初级卒中中心院内风险调整后的死亡率更高（优势比1.23，95%置信区间1.07 - 1.41）。