- 作者：Judith A. Hinchey ; Timothy Shephard ; Sarah T. Tonn ; Robin Ruthazer ; Richard C. Hermann ; Harry P. Selker ; David M. Kent
- 关键词：Acute stroke ; quality improvement ; performance measures ; evidence medicine ; diffusion of medical innovation
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：2010
- 出版时间：March 2010
- 年：2010
- 卷：19
- 期：2
- 页码：130-137
- 全文大小：257 K
Objective
The aim of this project was to determine whether a tailored multifaceted intervention aimed at site-specific barriers is more effective than audit feedback alone for improving adherence to inhospital stroke performance measures (PMs): door to needle time of less than 1 hour for tissue plasminogen activator, dysphagia screening, deep venous thrombosis prophylaxis, and warfarin treatment for atrial fibrillation.Methods
Hospitals were paired on baseline adherence to dysphagia screening and quality improvement infrastructure and randomized to receive audit feedback alone (n = 7) versus audit feedback plus site-specific interventions (n = 6). Data were collected on all admitted patients with stroke seen in the neurology department before and after a 6-month implementation period. The primary end point was the difference in postintervention adherence rates for each PM, except tissue plasminogen activator because of low sample size.
Results
Data were collected on 2071 preintervention patients and 1240 postintervention patients. Targeted site-specific interventions, such as standing orders and standardized dysphagia screens, were imperfectly implemented during the 6-month intervention period. For atrial fibrillation, the intervention group had an 11 % higher postintervention adherence rate beyond that of the control group (98 % v 87 % , P < .005). No other statistically significant changes in PM adherence were observed.
Conclusion
Implementation of site-specific interventions for quality improvement of specific measures in stroke was difficult to achieve in a 6-month time frame and led to improved adherence for only one of 3 PMs. Studies with a longer intervention period and more sites are required to determine whether tailored interventions can enhance stroke improvement.