Hansen Daniël, den Hartog Sanne J, van Leeuwen Nikki, Boiten Jelis, Dinkelaar Wouter, van Doormaal Pieter J, Eijkenaar Frank, Emmer Bart J, van Es Adriaan C G M, Flach H Zwenneke, Gons Rob, den Hertog M Heleen, Imani Farshad, Janssen Paula M, Kortman Hans, Kruyt Nyika D, Kuhrij Laurien S, van der Leij Christiaan, Lo T H Rob, van der Lugt Aad, Lycklama À Nijeholt Geert, Martens Jasper M M, Nederkoorn Paul J, Piet Jurgen, Remmers Michel J M, Roos Yvo B W E M, Silvis Suzanne M, Stolze Lotte J, Stomp Wouter, van Tuijl Julia H, Truijman Martine T B, Vermeer Sarah E, van Walderveen Marianne A A, van den Wijngaard Ido R, Van der Worp H Bart, Yo Lonneke, Dippel Diederik W J, Lingsma Hester F, Roozenbeek Bob
Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
JAMA Neurol. 2025 Feb 1;82(2):160-167. doi: 10.1001/jamaneurol.2024.4304.
Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback.
To evaluate the effect of performance feedback to hospitals on treatment times for EVT.
DESIGN, SETTING, AND PARTICIPANTS: This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023.
The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition.
The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models.
A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%).
This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke.
The Netherlands Trial Register: NL9090.
高效的护理流程对于最大限度减少缺血性中风患者血管内血栓切除术（EVT）后的治疗延迟及改善预后至关重要。改善护理流程的一种潜在方法是绩效反馈。
评估向医院提供绩效反馈对EVT治疗时间的影响。
设计、设置和参与者：这项整群随机临床试验于2020年1月1日至2022年6月30日进行。参与者为在13家荷兰医院接受EVT的连续成年缺血性中风患者。无患者被排除。数据分析于2023年3月至5月进行。
干预包括使用结构、流程和结果指标对医院绩效进行反馈。指标分数基于国家质量登记处的数据，并与基准进行比较。通过仪表盘向当地质量改进团队提供绩效反馈，这些团队根据反馈制定并实施改进计划。每6个月，随机选择3至4家医院转为干预组。
主要结局是所有接受EVT治疗患者从入院到股动脉穿刺的时间。次要结局包括入院到穿刺时间、第2天的美国国立卫生研究院卒中量表（NIHSS）评分、扩展脑梗死治疗（eTICI）评分以及3个月时的改良Rankin量表（mRS）评分。采用多变量线性混合模型估计干预效果。
共纳入4747例患者（干预组：2431例；对照组：2316例）。他们的平均（标准差）年龄为72（13）岁；女性2337例（49.2%），男性2410例（50.8%）。基线NIHSS评分的中位数（IQR）为14（8 - 19）。干预组从入院到股动脉穿刺时间的中位数（IQR）为47（25 - 71）分钟，而对照组为52（29 - 75）分钟。调整后的绝对缩短时间为5分钟（β = -4.8；95%CI，-9.5至-0.1；P = 0.04），相当于相对缩短9.2%（95%CI，-18.3%至-0.2%）。
本研究发现，通过当地质量改进团队使用的仪表盘提供绩效反馈可缩短EVT的入院到股动脉穿刺时间。在提供EVT的医院实施绩效反馈可提高缺血性中风的护理质量。
荷兰试验注册中心：NL9090
