Urimubenshi Gerard, Langhorne Peter, Cadilhac Dominique A, Kagwiza Jeanne N, Wu Olivia
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Eur Stroke J. 2017 Dec;2(4):287-307. doi: 10.1177/2396987317735426. Epub 2017 Oct 5.
Translating research evidence into clinical practice often uses key performance indicators to monitor quality of care. We conducted a systematic review to identify the stroke key performance indicators used in large registries, and to estimate their association with patient outcomes.
We sought publications of recent (January 2000-May 2017) national or regional stroke registers reporting the association of key performance indicators with patient outcome (adjusting for age and stroke severity). We searched Ovid Medline, EMBASE and PubMed and screened references from bibliographies. We used an inverse variance random effects meta-analysis to estimate associations (odds ratio; 95% confidence interval) with death or poor outcome (death or disability) at the end of follow-up.
We identified 30 eligible studies (324,409 patients). The commonest key performance indicators were swallowing/nutritional assessment, stroke unit admission, antiplatelet use for ischaemic stroke, brain imaging and anticoagulant use for ischaemic stroke with atrial fibrillation, lipid management, deep vein thrombosis prophylaxis and early physiotherapy/mobilisation. Lower case fatality was associated with stroke unit admission (odds ratio 0.79; 0.72-0.87), swallow/nutritional assessment (odds ratio 0.78; 0.66-0.92) and antiplatelet use for ischaemic stroke (odds ratio 0.61; 0.50-0.74) or anticoagulant use for ischaemic stroke with atrial fibrillation (odds ratio 0.51; 0.43-0.64), lipid management (odds ratio 0.52; 0.38-0.71) and early physiotherapy or mobilisation (odds ratio 0.78; 0.67-0.91). Reduced poor outcome was associated with adherence to swallowing/nutritional assessment (odds ratio 0.58; 0.43-0.78) and stroke unit admission (odds ratio 0.83; 0.77-0.89). Adherence with several key performance indicators appeared to have an additive benefit.
Adherence with common key performance indicators was consistently associated with a lower risk of death or disability after stroke.
Policy makers and health care professionals should implement and monitor those key performance indicators supported by good evidence.
将研究证据转化为临床实践通常会使用关键绩效指标来监测医疗质量。我们进行了一项系统评价，以确定大型登记处使用的卒中关键绩效指标，并评估它们与患者预后的关联。
我们查找了近期（2000年1月至2017年5月）国家或地区卒中登记处报告关键绩效指标与患者预后关联（校正年龄和卒中严重程度）的出版物。我们检索了Ovid Medline、EMBASE和PubMed，并筛选了参考文献目录中的文献。我们使用逆方差随机效应荟萃分析来评估随访结束时与死亡或不良预后（死亡或残疾）的关联（比值比；95%置信区间）。
我们确定了30项符合条件的研究（324,409例患者）。最常见的关键绩效指标是吞咽/营养评估、入住卒中单元、缺血性卒中使用抗血小板药物、脑成像以及缺血性卒中合并心房颤动时使用抗凝药物、血脂管理、预防深静脉血栓形成和早期物理治疗/活动。较低的病死率与入住卒中单元（比值比0.79；0.72 - 0.87）、吞咽/营养评估（比值比0.78；0.66 - 0.92）、缺血性卒中使用抗血小板药物（比值比0.61；0.50 - 0.74）或缺血性卒中合并心房颤动时使用抗凝药物（比值比0.51；0.43 - 0.64）、血脂管理（比值比0.
