Novarro-Escudero Nelson, Moon Yoon Ji, Olmedo Argelis, Ferguson Teresa, Caballero Ileana, Onodera Eduardo, Effio Euclides, Klein Lisa M, Zink Elizabeth K, Johnson Brenda, Urrutia Victor C
Primary Stroke Center, Pacífica Salud, Hospital Punta Pacífica, Panamá, Panama.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Front Neurol. 2021 Aug 16;12:684775. doi: 10.3389/fneur.2021.684775. eCollection 2021.
Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation. To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017-2019. Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement. A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT. We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program.
中风是全球第二大致死和致残原因。在许多高收入国家，中风中心已成为现代中风服务的核心组成部分，但在低收入、中等收入和新兴高收入国家，其可行性和有效性尚不清楚。此外，尽管有国际指南，但全球许多医院并未提供有组织的临床中风护理。我们提出一种方法，以帮助医院建立中风中心并在实施后审查质量数据。描述并比较2017 - 2019年的头三年里，太平洋健康集团蓬塔太平洋医院（PSHPP）中风中心的人口统计学、表现及临床结果。太平洋健康集团蓬塔太平洋医院依据国际指南的最佳实践和质量改进流程，组织实施护理方案。实施方法采用了一种将医学证据转化为实践，以实施循证实践的模式。这是一项回顾性研究，对2017年3月至2019年12月期间因原发性中风诊断入住PSHPP的患者前瞻性收集的质量数据进行分析。收集的数据包括人口统计学、按照联合委员会的STK绩效指标整理的临床数据、从入院到穿刺、从入院到腹股沟穿刺的时间、90天改良Rankin评分，以及静脉溶栓和机械取栓（MT）的出血并发症。主要结果：逐年记录绩效指标的熟练程度。次要结果：逐年改善情况。共有143例患者因急性缺血性中风、短暂性脑缺血发作（TIA）或出血性中风入院。其中，2017年入院36例，2018年入院50例，2019年入院57例。在逐年分析中，绩效指标的熟练程度有所提高，患者总数以及接受静脉溶栓和MT治疗的患者数量也有所增加。我们展示了巴拿马一个中风项目实施的方法和结果。该项目是该国及中美洲首个获得联合委员会国际（JCI）认证的初级中风中心（PSC）。我们推测，管理指南的传播不足以鼓励中风中心的发展。在有指导的情况下，应用将证据转化为实践的方法促进了该项目的成功。
