Abstract WP372: Quality Improvement in Acute Ischemic Stroke Care in Taiwan: the Breakthrough Collaborative in Stroke
Background and Purpose: Guideline adherence for acute ischemic stroke (AIS) management is often suboptimal, particularly in thrombolytic therapy and anticoagulants for atrial fibrillation. We sought to achieve quality improvement of AIS patients via a collaborative learning model, the Breakthrough Series (BTS)-Stroke, in a nationwide, multi-center activity in Taiwan.
Methods: A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance AIS care quality. There were 24 teaching and community hospitals participating in and submitting data for this stroke quality improvement campaign from August 2010 to June 2011. The Get With The Guideline (GWTG)-Stroke measures were adopted to evaluate the performance and outcome of the AIS patients. The results of this study were compared to those of the previous Taiwan Stroke Registry (TSR, 22642 AIS patients from 39 hospitals, 2006-08).
Results: Data from 24 hospitals with 13181 AIS patients during a 1-year period were analyzed. The BTS-Stroke (2010-11) had better performance as compared to the TSR (2006-08): intravenous thrombolysis frequency for all AIS patients (4.1% vs 1.5%), symptomatic hemorrhage after intravenous thrombolysis (6.0% vs 8.2%), early antithrombotics (96.6% vs 94.1%), anticoagulation for atrial fibrillation (57.1% vs 28.3%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (63.4% vs 38.7%), antithrombotics at discharge (94.0% vs 85.5%), and one-month mortality (3.5% vs 4.0%). Temporal improvement was noted in 7 of 14 performance measures when the fourth BTS-Stroke quarter compared with the first quarter: intravenous thrombolysis frequency for all AIS patients (4.1% vs 3.7%), symptomatic hemorrhage after intravenous thrombolysis (3.4% vs 5.5%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (67.3% vs 60.5%), antithrombotics at discharge (95.5% vs 91.4%), dysphagia screening (81.9% vs 63.4%), early rehabilitation (71.7% vs 63.6%), stroke education before discharge (95.6% vs 83.4%).
Conclusions: A BTS collaborative learning and campaign model can improve the guideline adherence of stroke. The GWTG-Stroke can be successfully applied to other countries outside the United States.
- © 2012 by American Heart Association, Inc.