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. 2024 Apr 18:15:1364952.
doi: 10.3389/fneur.2024.1364952. eCollection 2024.

Effectiveness of the acute stroke care map program in reducing in-hospital delay for acute ischemic stroke in a Chinese urban area: an interrupted time series analysis

Rui Wen  1 , Miaoran Wang  2 , Wei Bian  3 , Haoyue Zhu  3 , Ying Xiao  3 , Jing Zeng  4 , Qian He  1 , Yu Wang  1 , Xiaoqing Liu  1 , Yangdi Shi  1 , Zhe Hong  3 , Bing Xu  1
Affiliations

Effectiveness of the acute stroke care map program in reducing in-hospital delay for acute ischemic stroke in a Chinese urban area: an interrupted time series analysis

Rui Wen et al. Front Neurol. .

Abstract

Background: Timely intravenous thrombolysis (IVT) is crucial for improving outcomes in acute ischemic stroke (AIS) patients. This study evaluates the effectiveness of the Acute Stroke Care Map (ASCaM) initiative in Shenyang, aimed at reducing door-to-needle times (DNT) and thus improving the timeliness of care for AIS patients.

Methods: An retrospective cohort study was conducted from April 2019 to December 2021 in 30 hospitals participating in the ASCaM initiative in Shenyang. The ASCaM bundle included strategies such as EMS prenotification, rapid stroke triage, on-call stroke neurologists, immediate neuroimaging interpretation, and the innovative Pre-hospital Emergency Call and Location Identification feature. An interrupted time series analysis (ITSA) was used to assess the impact of ASCaM on DNT, comparing 9 months pre-intervention with 24 months post-intervention.

Results: Data from 9,680 IVT-treated ischemic stroke patients were analyzed, including 2,401 in the pre-intervention phase and 7,279 post-intervention. The ITSA revealed a significant reduction in monthly DNT by -1.12 min and a level change of -5.727 min post-ASCaM implementation.

Conclusion: The ASCaM initiative significantly reduced in-hospital delays for AIS patients, demonstrating its effectiveness as a comprehensive stroke care improvement strategy in urban settings. These findings highlight the potential of coordinated care interventions to enhance timely access to reperfusion therapies and overall stroke prognosis.

Keywords: acute ischemic stroke; acute stroke care map; in-hospital delay; interrupted time-series analysis; program.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Shenyang acute stroke care map. The geographical locations of all 30 participating hospitals are displayed.
Figure 2
Figure 2
Patient selection process.
Figure 3
Figure 3
Interrupted time series analysis, all ischaemic stroke patients.
Figure 4
Figure 4
Subset interrupted time series analysis using admission NIHSS score and age as stratifying variables. (A) Admission NIHSS score ≥6; (B) Admission NIHSS score <6; (C) Age ≥65 years; (D) Age <65 years.
See this image and copyright information in PMC

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