Quality improvement in acute ischemic stroke care in Taiwan: The breakthrough collaborative in stroke

Fang I. Hsieh, Jiann Shing Jeng, Chang Ming Chern, Tsong Hai Lee, Sung Chun Tang, Li Kai Tsai, Hsun Hsiang Liao, Hang Chang, Kenneth A. Labresh, Hung Jung Lin, Hung Yi Chiou, Hou Chang Chiu, Li Ming Lien

研究成果: 雜誌貢獻文章

10 引文 (Scopus)

摘要

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.
原文英語
文章編號e0160426
期刊PLoS One
11
發行號8
DOIs
出版狀態已發佈 - 八月 1 2016

指紋

Quality Improvement
Taiwan
stroke
Stroke
Composite materials
Needles
Learning systems
Guideline Adherence
Quality of Health Care
Atrial Fibrillation
Guidelines
hemorrhage
learning

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

引用此文

Quality improvement in acute ischemic stroke care in Taiwan : The breakthrough collaborative in stroke. / Hsieh, Fang I.; Jeng, Jiann Shing; Chern, Chang Ming; Lee, Tsong Hai; Tang, Sung Chun; Tsai, Li Kai; Liao, Hsun Hsiang; Chang, Hang; Labresh, Kenneth A.; Lin, Hung Jung; Chiou, Hung Yi; Chiu, Hou Chang; Lien, Li Ming.

於: PLoS One, 卷 11, 編號 8, e0160426, 01.08.2016.

研究成果: 雜誌貢獻文章

Hsieh, FI, Jeng, JS, Chern, CM, Lee, TH, Tang, SC, Tsai, LK, Liao, HH, Chang, H, Labresh, KA, Lin, HJ, Chiou, HY, Chiu, HC & Lien, LM 2016, 'Quality improvement in acute ischemic stroke care in Taiwan: The breakthrough collaborative in stroke', PLoS One, 卷 11, 編號 8, e0160426. https://doi.org/10.1371/journal.pone.0160426
Hsieh, Fang I. ; Jeng, Jiann Shing ; Chern, Chang Ming ; Lee, Tsong Hai ; Tang, Sung Chun ; Tsai, Li Kai ; Liao, Hsun Hsiang ; Chang, Hang ; Labresh, Kenneth A. ; Lin, Hung Jung ; Chiou, Hung Yi ; Chiu, Hou Chang ; Lien, Li Ming. / Quality improvement in acute ischemic stroke care in Taiwan : The breakthrough collaborative in stroke. 於: PLoS One. 2016 ; 卷 11, 編號 8.
@article{b2ac001cdb0844119e31ad5ba81f53cc,
title = "Quality improvement in acute ischemic stroke care in Taiwan: The breakthrough collaborative in stroke",
abstract = "In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2{\%} to 4.6{\%}, door-to-needle time ≤60 minutes improved from 7.1{\%} to 50.8{\%}, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0{\%} to 5.6{\%}, and anticoagulation therapy for atrial fibrillation increased from 32.1{\%} to 64.1{\%}. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75{\%} to 86.3{\%}, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.",
author = "Hsieh, {Fang I.} and Jeng, {Jiann Shing} and Chern, {Chang Ming} and Lee, {Tsong Hai} and Tang, {Sung Chun} and Tsai, {Li Kai} and Liao, {Hsun Hsiang} and Hang Chang and Labresh, {Kenneth A.} and Lin, {Hung Jung} and Chiou, {Hung Yi} and Chiu, {Hou Chang} and Lien, {Li Ming}",
year = "2016",
month = "8",
day = "1",
doi = "10.1371/journal.pone.0160426",
language = "English",
volume = "11",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "8",

}

TY - JOUR

T1 - Quality improvement in acute ischemic stroke care in Taiwan

T2 - The breakthrough collaborative in stroke

AU - Hsieh, Fang I.

AU - Jeng, Jiann Shing

AU - Chern, Chang Ming

AU - Lee, Tsong Hai

AU - Tang, Sung Chun

AU - Tsai, Li Kai

AU - Liao, Hsun Hsiang

AU - Chang, Hang

AU - Labresh, Kenneth A.

AU - Lin, Hung Jung

AU - Chiou, Hung Yi

AU - Chiu, Hou Chang

AU - Lien, Li Ming

PY - 2016/8/1

Y1 - 2016/8/1

N2 - In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.

AB - In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.

UR - http://www.scopus.com/inward/record.url?scp=84982107417&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982107417&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0160426

DO - 10.1371/journal.pone.0160426

M3 - Article

C2 - 27487190

AN - SCOPUS:84982107417

VL - 11

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 8

M1 - e0160426

ER -