中国卒中中心联盟数据显示：急性卒中患者在初级卒中中心与综合卒中中心的医疗质量比较
Comparison between healthcare quality in primary stroke centers and comprehensive stroke centers for acute stroke patients: evidence from the Chinese Stroke Center Alliance.
作者信息
Liu Zeyu, Gu Hongqiu, Wei Minping, Feng Xianjing, Yu Fang, Feng Jie, Li Zixiao, Xia Jian, Yang Xin
机构信息
Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, Hunan, China.
出版信息
Lancet Reg Health West Pac. 2023 Aug 3;38:100863. doi: 10.1016/j.lanwpc.2023.100863. eCollection 2023 Sep.
BACKGROUND
To improve stroke care quality, the guidelines for stroke center construction in China recommended establishing primary stroke centers (PSCs) and comprehensive stroke centers (CSCs). We aimed to compare stroke care quality between the two types of centers.
METHODS
Data were collected from acute stroke patients admitted to PSCs or CSCs in the China Stroke Center Alliance program. Twenty-one individual guideline-recommended performance measures and two summary measures were compared between the two groups. Multivariable logistic regression models were used to examine the association between stroke center status (CSC vs. PSC) and healthcare quality.
FINDINGS
Data from 750,594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. For many components of healthcare performance in stroke patients, comparable levels of performance were observed between CSCs and PCSs. Nonetheless, CSCs outperformed PSCs in the areas of administering intravenous recombinant tissue plasminogen activator within 4.5 h (aOR = 1.31 [95% CI: 1.07-1.60]), rehabilitation for acute ischaemic stroke (AIS) (aOR = 1.19 [95% CI: 1.01-1.40]), and the provision of hypoglycemic medication and statin therapy upon discharge for AIS (aOR = 1.26 [95% CI: 1.00-1.59] and aOR = 1.28 [95% CI: 1.04-1.59], respectively). More patients with intracerebral haemorrhage and subarachnoid haemorrhage received neurosurgery in CSCs (14.4% vs. 10.6% and 51.0% vs. 33.9%, respectively). Additionally, CSCs had higher in-hospital mortality than PSCs (aOR = 1.33 [95% CI: 1.01-1.73]).
INTERPRETATION
Overall PSCs provided equivalent care for many quality measures to CSCs in China with the exception of thrombolysis, rehabilitation access, and medication at discharge for AIS, whereby improvements should be directed. Nevertheless, PSCs have demonstrated lower risk-adjusted in-hospital mortality rates.
FUNDING
The National Key Research and Development Projects of China.
背景
为提高卒中医疗质量，中国卒中中心建设指南建议建立初级卒中中心（PSC）和综合卒中中心（CSC）。我们旨在比较这两种类型中心的卒中医疗质量。
方法
收集中国卒中中心联盟项目中入住PSC或CSC的急性卒中患者的数据。比较两组之间21项指南推荐的个体绩效指标和两项综合指标。使用多变量逻辑回归模型来检验卒中中心状态（CSC与PSC）与医疗质量之间的关联。
结果
分析了来自1474个卒中中心（252个CSC和1222个PSC）的750594例卒中患者的数据。在卒中患者医疗绩效的许多方面，CSC和PSC的绩效水平相当。尽管如此，CSC在以下方面表现优于PSC：在4.5小时内给予静脉注射重组组织型纤溶酶原激活剂（调整后比值比[aOR]=1.31[95%置信区间（CI）：1.07 - 1.60]）、急性缺血性卒中（AIS）的康复治疗（aOR = 1.19[95%CI：1.01 - 1.40]）以及AIS出院时提供降糖药物和他汀类药物治疗（分别为aOR = 1.26[95%CI：1.00 - 1.59]和aOR = 1.28[95%CI：1.04 - 1.59]）。更多的脑出血和蛛网膜下腔出血患者在CSC接受了神经外科手术（分别为14.4%对10.6%和51.0%对33.9%）。此外，CSC的院内死亡率高于PSC（aOR = 1.33[95%CI：1.01 - 1.73]）。
解读
总体而言，在中国，除了溶栓、康复治疗和AIS出院时的药物治疗外，PSC在许多质量指标方面为CSC提供了同等的医疗服务，应针对这些方面进行改进。然而，PSC已显示出风险调整后的院内死亡率较低。
资助
中国国家重点研发项目。
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