Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months
Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 1...
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doaj-69b726659859499aa23554b867d742dd2021-09-26T02:30:05ZengBMJ Publishing GroupStroke and Vascular Neurology2059-86962021-03-016110.1136/svn-2020-000332Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 monthsLijie Ren0Yao Zhang1Ying Xiao2Jianfeng Luo3Chunyao Dong4Weijin Zhao5Li Ren6Haoyue Zhu7Qi Fang8Weidong Liu9Bing Xu107 Department of Neurology, Shenzhen University 1st Affiliated Hospital, Shenzhen Second People’s Hospital, Shenzhen, China 1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China 1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China 2 Department of Biostatistics, Fudan University School of Public Health, Shanghai, China1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, China8 Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China 10 Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng, China1 Department of Neurology, Shenyang Brain Hospital, Shenyang Medical College, Shenyang, ChinaBackground The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.Results Compared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.https://svn.bmj.com/content/6/1/87.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lijie Ren Yao Zhang Ying Xiao Jianfeng Luo Chunyao Dong Weijin Zhao Li Ren Haoyue Zhu Qi Fang Weidong Liu Bing Xu |
spellingShingle |
Lijie Ren Yao Zhang Ying Xiao Jianfeng Luo Chunyao Dong Weijin Zhao Li Ren Haoyue Zhu Qi Fang Weidong Liu Bing Xu Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months Stroke and Vascular Neurology |
author_facet |
Lijie Ren Yao Zhang Ying Xiao Jianfeng Luo Chunyao Dong Weijin Zhao Li Ren Haoyue Zhu Qi Fang Weidong Liu Bing Xu |
author_sort |
Lijie Ren |
title |
Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months |
title_short |
Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months |
title_full |
Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months |
title_fullStr |
Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months |
title_full_unstemmed |
Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months |
title_sort |
implementation of regional acute stroke care map increases thrombolysis rates for acute ischaemic stroke in chinese urban area in only 3 months |
publisher |
BMJ Publishing Group |
series |
Stroke and Vascular Neurology |
issn |
2059-8696 |
publishDate |
2021-03-01 |
description |
Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in China. We investigated whether the implementation of a citywide Acute Stroke Care Map (ASCaM) is associated with an improvement of acute stroke care quality in a Chinese urban area.Methods The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary hospitals. We identified 7827 patients with ischaemic stroke admitted from April to October 2017, and 506 patients underwent thrombolysis were finally included for analysis.Results Compared with ‘pre-ASCaM period’, we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours (65.4% vs 54.5%; adjusted OR, 1.724; 95% CI 1.21 to 2.45; p=0.003) during ‘ASCaM period’. In multivariate analysis models, ‘ASCaM period’ was associated with a significant reduction in onset-to-door time (114.1±55.7 vs 135.7±58.4 min, p=0.0002) and onset-to-needle time (ONT) (169.2±58.1 vs 195.6±59.3 min, p<0.0001). Yet no change was found in door-to-needle time. Clinical outcomes such as symptomatic intracranial haemorrhage, favourable functional outcome (modified Rankin Scale ≤2) and in-hospital mortality remained unchanged.Conclusion The implementation of ASCaM was significantly associated with increased rates of intravenous thrombolysis and shorter ONT. The ASCaM may, in proof-of-principle, serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions. |
url |
https://svn.bmj.com/content/6/1/87.full |
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