Document Detail


The Stroke Practice Improvement Network: a quasiexperimental trial of a multifaceted intervention to improve quality.
MedLine Citation:
PMID:  20189089     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Judith A Hinchey; Timothy Shephard; Sarah T Tonn; Robin Ruthazer; Richard C Hermann; Harry P Selker; David M Kent
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  19     ISSN:  1532-8511     ISO Abbreviation:  J Stroke Cerebrovasc Dis     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-01     Completed Date:  2010-06-08     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  130-7     Citation Subset:  IM    
Copyright Information:
Copyright 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / therapeutic use
Atrial Fibrillation / complications,  drug therapy,  prevention & control
Combined Modality Therapy / standards
Commission on Professional and Hospital Activities
Deglutition Disorders / diagnosis,  etiology
Emergency Medical Services / methods,  standards*
Emergency Service, Hospital / standards
Feedback
Female
Guideline Adherence / standards*,  trends
Humans
Intensive Care Units / standards
Male
Mass Screening
Quality Assurance, Health Care / methods*
Quality of Health Care
Stroke / complications,  diagnosis,  therapy*
Tissue Plasminogen Activator / therapeutic use
Venous Thrombosis / drug therapy,  etiology,  prevention & control
Warfarin / administration & dosage
Grant Support
ID/Acronym/Agency:
K23 NS002163/NS/NINDS NIH HHS; K23 NS002163-05/NS/NINDS NIH HHS; K23NS002163/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 5Q7ZVV76EI/Warfarin; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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