Daniël Hansen, Sanne J den Hartog, Nikki van Leeuwen, Jelis Boiten, Wouter Dinkelaar, Pieter J van Doormaal, Frank Eijkenaar, Bart J Emmer, Adriaan C G M van Es, H Zwenneke Flach, Rob Gons, M Heleen den Hertog, Farshad Imani, Paula M Janssen, Hans Kortman, Nyika D Kruyt, Laurien S Kuhrij, Christiaan van der Leij, T H Rob Lo, Aad van der Lugt, Geert Lycklama À Nijeholt, Jasper M M Martens, Paul J Nederkoorn, Jurgen Piet, Michel J M Remmers, Yvo B W E M Roos, Suzanne M Silvis, Lotte J Stolze, Wouter Stomp, Julia H van Tuijl, Martine T B Truijman, Sarah E Vermeer, Marianne A A van Walderveen, Ido R van den Wijngaard, H Bart Van der Worp, Lonneke Yo, Diederik W J Dippel, Hester F Lingsma, Bob Roozenbeek
{"title":"Quality Improvement Intervention for Reducing Acute Treatment Times in Ischemic Stroke: A Cluster Randomized Clinical Trial.","authors":"Daniël Hansen, Sanne J den Hartog, Nikki van Leeuwen, Jelis Boiten, Wouter Dinkelaar, Pieter J van Doormaal, Frank Eijkenaar, Bart J Emmer, Adriaan C G M van Es, H Zwenneke Flach, Rob Gons, M Heleen den Hertog, Farshad Imani, Paula M Janssen, Hans Kortman, Nyika D Kruyt, Laurien S Kuhrij, Christiaan van der Leij, T H Rob Lo, Aad van der Lugt, Geert Lycklama À Nijeholt, Jasper M M Martens, Paul J Nederkoorn, Jurgen Piet, Michel J M Remmers, Yvo B W E M Roos, Suzanne M Silvis, Lotte J Stolze, Wouter Stomp, Julia H van Tuijl, Martine T B Truijman, Sarah E Vermeer, Marianne A A van Walderveen, Ido R van den Wijngaard, H Bart Van der Worp, Lonneke Yo, Diederik W J Dippel, Hester F Lingsma, Bob Roozenbeek","doi":"10.1001/jamaneurol.2024.4304","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback.</p><p><strong>Objective: </strong>To evaluate the effect of performance feedback to hospitals on treatment times for EVT.</p><p><strong>Design, setting, and participants: </strong>This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023.</p><p><strong>Intervention: </strong>The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition.</p><p><strong>Main outcome and measures: </strong>The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models.</p><p><strong>Results: </strong>A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%).</p><p><strong>Conclusion and relevance: </strong>This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke.</p><p><strong>Trial registration: </strong>The Netherlands Trial Register: NL9090.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaneurol.2024.4304","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Importance: Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback.
Objective: To evaluate the effect of performance feedback to hospitals on treatment times for EVT.
Design, setting, and participants: This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023.
Intervention: The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition.
Main outcome and measures: The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models.
Results: A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%).
Conclusion and relevance: This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke.
Trial registration: The Netherlands Trial Register: NL9090.
期刊介绍：
JAMA Neurology is an international peer-reviewed journal for physicians caring for people with neurologic disorders and those interested in the structure and function of the normal and diseased nervous system. The Archives of Neurology & Psychiatry began publication in 1919 and, in 1959, became 2 separate journals: Archives of Neurology and Archives of General Psychiatry. In 2013, their names changed to JAMA Neurology and JAMA Psychiatry, respectively. JAMA Neurology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications.
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