Wang Y, et al. - If hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke (AIS) can be improved by a multifaceted quality improvement intervention in China was investigated. In this study, a multifaceted intervention vs usual care led to a small but significant improvement in personnel adherence to evidence-based performance measures when assessed as a composite measure but not as an all-or-none measure.

Methods

• Among 40 public hospitals in China, researchers performed a multicenter, cluster-randomized clinical trial that enrolled 4,800 patients hospitalized with AIS from August 10, 2014 through June 20, 2015 with 12-month follow-up through July 30, 2016.
• A multifaceted quality improvement intervention (intervention group; 2,400 patients), including a clinical pathway, care protocols, quality coordinator oversight, and performance measure monitoring and feedback, was implemented in 20 hospitals, while in the stroke registry, 20 hospitals participated with usual care (control group; 2400 patients).
• Hospital personnel adherence to nine AIS performance measures was assessed as the primary outcome; co-primary outcomes included a composite of percentage of performance measures adhered to, and as all-or-none.
• In-hospital mortality and long-term outcomes (a new vascular event, disability [modified Rankin Scale score, 3-5], and all-cause mortality) at 3, 6, and 12 months were assessed as secondary outcomes.

Results

• Patients in intervention group vs those in the control groups had a higher likelihood of receiving performance measures (composite measure, 88.2% vs 84.8%, respectively; absolute difference, 3.54% [95% CI, 0.68% to 6.40%], P=.02).
• The intervention and control groups did not differ significantly in terms of all-or-none measure (53.8% vs 47.8%, respectively; absolute difference, 6.69% [95% CI, -0.41% to 13.79%], P=.06).
• The intervention group displayed significantly reduced new clinical vascular events compared with the control group at 3 months (3.9% vs 5.3%, respectively; difference, -2.03% [95% CI, -3.51% to -0.55%]; P=.007), 6 months (6.3% vs 7.8%, respectively; difference, -2.18% [95% CI, -4.0% to -0.35%]; P=.02) and 12 months (9.1% vs 11.8%, respectively; difference, -3.13% [95% CI, -5.28% to -0.97%]; P=.005).