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Randomized Controlled Trial
. 2010 Mar;19(2):130-7.
doi: 10.1016/j.jstrokecerebrovasdis.2009.03.016.

The Stroke Practice Improvement Network: a quasiexperimental trial of a multifaceted intervention to improve quality

Judith A Hinchey  1 , Timothy Shephard, Sarah T Tonn, Robin Ruthazer, Richard C Hermann, Harry P Selker, David M Kent
Affiliations
Randomized Controlled Trial

The Stroke Practice Improvement Network: a quasiexperimental trial of a multifaceted intervention to improve quality

Judith A Hinchey et al. J Stroke Cerebrovasc Dis. 2010 Mar.

Abstract

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.

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Conflict of interest statement

Drs. Hinchey, Shephard, Herman, Selker, Kent or Ms. Ruthazer and Tonn have no potential financial or other conflicts of interest to disclose.

Figures

Figure 1
Figure 1. Changes in adherence rates
Changes in pre intervention to post intervention adherence rates for each performance measure by group.
See this image and copyright information in PMC

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