Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Japan (N.R., S.O., E.K., K.N.).
Department of Neurosurgery (N.R., A.N.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Stroke. 2022 Nov;53(11):3359-3368. doi: 10.1161/STROKEAHA.121.038483. Epub 2022 Aug 16.
Quality indicators (QIs) are an accepted tool for measuring a hospital's performance in routine care. We examined national trends in adherence to the QIs developed by the Close The Gap-Stroke program by combining data from the health insurance claims database and electronic medical records, and the association between adherence to these QIs and early outcomes in patients with acute ischemic stroke in Japan.
In the present study, patients with acute ischemic stroke who received acute reperfusion therapy in 351 Close The Gap-Stroke-participating hospitals were analyzed retrospectively. The primary outcomes were changes in trends for adherence to the defined QIs by difference-in-difference analysis and the effects of adherence to distinct QIs on in-hospital outcomes at the individual level. A mixed logistic regression model was adjusted for patient and hospital characteristics (eg, age, sex, number of beds) and hospital units as random effects.
Between 2013 and 2017, 21 651 patients (median age, 77 years; 43.0% female) were assessed. Of the 25 defined measures, marked and sustainable improvement in the adherence rates was observed for door-to-needle time, door-to-puncture time, proper use of endovascular thrombectomy, and successful revascularization. The in-hospital mortality rate was 11.6%. Adherence to 14 QIs lowered the odds of in-hospital mortality (odds ratio [95% CI], door-to-needle <60 min, 0.80 [0.69-0.93], door-to-puncture <90 min, 0.80 [0.67-0.96], successful revascularization, 0.40 [0.34-0.48]), and adherence to 11 QIs increased the odds of functional independence (modified Rankin Scale score 0-2) at discharge.
We demonstrated national marked and sustainable improvement in adherence to door-to-needle time, door-to-puncture time, and successful reperfusion from 2013 to 2017 in Japan in patients with acute ischemic stroke. Adhering to the key QIs substantially affected in-hospital outcomes, underlining the importance of monitoring the quality of care using evidence-based QIs and the nationwide Close The Gap-Stroke program.
质量指标（QIs）是衡量医院常规护理绩效的一种公认工具。我们通过结合健康保险索赔数据库和电子病历的数据，研究了日本符合“缩小差距-卒中”项目制定的 QIs 的依从性的全国趋势，以及这些 QIs 的依从性与急性缺血性卒中患者早期结局之间的关联。
本研究回顾性分析了 351 家参与“缩小差距-卒中”项目的医院接受急性再灌注治疗的急性缺血性卒中患者。主要结局是通过差异分析评估依从定义 QIs 的趋势变化，以及在个体水平上依从特定 QIs 对住院结局的影响。混合逻辑回归模型调整了患者和医院特征（如年龄、性别、床位数量）和医院科室作为随机效应。
2013 年至 2017 年间，评估了 21651 例患者（中位数年龄为 77 岁，43.0%为女性）。在 25 项定义的措施中，门到针时间、门到穿刺时间、血管内血栓切除术的正确使用和成功再通的依从率显著且持续提高。住院死亡率为 11.6%。14 项 QIs 的依从性降低了住院死亡率的可能性（比值比[95%置信区间]，门到针时间<60 分钟，0.80[0.69-0.93]；门到穿刺时间<90 分钟，0.80[0.67-0.96]；成功再通，0.40[0.34-0.48]），11 项 QIs 的依从性增加了出院时功能独立性（改良 Rankin 量表评分 0-2）的可能性。
我们表明，在日本急性缺血性卒中患者中，2013 年至 2017 年期间，门到针时间、门到穿刺时间和成功再通的依从性显著且持续提高。坚持关键 QIs 对住院结局有显著影响，这突出了使用基于证据的 QIs 监测护理质量和全国范围内的“缩小差距-卒中”项目的重要性。
