Once again measuring the wrong thing; 'care'.
There is no quality here if you don't measure the right things.
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tPA full recovery? Better than 12%?
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30 day deaths? Better than competitors?
rehab full recovery? Better than 10%?
rehab full recovery? Better than 10%?
“What's measured, improves.” So said management legend and author Peter F. Drucker
The latest here:
Effect of the Shanghai Stroke Service System (4S) on the quality of stroke care and outcomes: A prospective quality improvement project
Abstract
Background:
In China, disparities in the quality of stroke care still exist and implementing quality improvement is still a challenge.
Aim:
The
aim of the study was to determine whether the intervention by Shanghai
Stroke Service System (4S) has helped improve adherence to stroke care
guidelines and patient outcome.
Methods:
The
4S is a regional stroke network with real-time data extraction among
its 61 stroke centers in Shanghai. A total of 11 key performance
indicators (KPIs) were evaluated. The primary outcomes were a composite
measure and an all-or-none measure of adherence to 11 KPIs. The
secondary outcomes were length of hospital stay and in-hospital
mortality.
Results:
The
study enrolled 92,395 patients (mean age 69.0 ± 12.5 years, 65.2% men)
with acute ischemic stroke hospitalized within 7 days of onset in
Shanghai from January 2015 to December 2020. More patients received
guideline recommended care between 2018 and 2020 than those between 2015
and 2017 (composite measure 87.1% vs 83.6%; absolute difference 2.9%,
95% confidence interval (CI) = [2.7%, 3.2%], p < 0.001; all-or-none
measure 49.2% vs 44.8% patients; absolute difference 3.5%, 95% CI =
[2.7%, 4.2%], p < 0.001). Further analysis of individual KPIs showed
an absolute increase in six KPIs ranging from 3.4% to 8.9% (p < 0.001
for all comparisons). Compared with 2015–2017, hospital length of stay
was shorter (10.95 vs 11.90 days; absolute difference –1.08, 95% CI =
[–1.18, –0.99], p < 0.001), and in-hospital mortality was
significantly reduced (risk ratio (RR) = 0.88, 95% CI = [0.79, 0.98],
p = 0.01) in 2018–2020.
Conclusion:
The
4S intervention was associated with increased adherence to the stroke
care guidelines, which further translated to improved clinical outcomes.
Trial registration:
ClinicalTrials.gov identifier: NCT02735226.
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