Background and Purpose:Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes.Methods:A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback.Results:Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51–93) to 39.0 minutes (interquartile range, 27–58) for patients treated per guideline (P<0.0001). The percentage of patients discharged home from acute care increased from 45.6% to 59.5% (P<0.0001); the median 90-day home time increased from 43.3 days (interquartile range, 27.3–55.8) to 53.6 days (interquartile range, 36.8–64.6) (P=0.0015); and the in-hospital mortality decreased from 14.5% to 10.5% (P=0.0990).Conclusions:The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta.

中文翻译：

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省级“针对针改善计划”在整个人群中改善了患者的治疗效果。

背景与目的：改善急性缺血性卒中患者溶栓的门到针时间（DNT）可以改善结局，但参与DNT改善计划的参与者大多仅限于对卒中质量改善已有兴趣的大型学术医疗中心。尚不清楚质量改进计划是否可以在人口规模（包括较小的社区医院）上改善DNT。这项研究旨在确定省级改善协作干预对DNT和患者预后的改善效果。方法：在加拿大艾伯塔省的17个指定中风中心进行了为期10年的队列前研究。该研究包括加拿大艾伯塔省的所有溶栓性缺血性卒中患者。质量改善干预是一项改善协作，涉及从每个卒中中心创建跨学科团队，参加3个讲习班和闭幕庆典，现场访问，网络研讨会以及数据审核和反馈。结果：248个缺血性卒中患者在干预前和干预后（溶栓后为630）接受了溶栓治疗。平均年龄为71岁（标准差为14.6岁），女性为46％。对于按照指南治疗的患者，DNTs从中位值70.0分钟（四分位间距51-93）减少到39.0分钟（四分位间距27-58）（248例缺血性中风患者在干预前后均接受了溶栓治疗（术后630例）。平均年龄为71岁（标准差为14.6岁），女性为46％。对于按照指南治疗的患者，DNTs从中位值70.0分钟（四分位间距51-93）减少到39.0分钟（四分位间距27-58）（248例缺血性中风患者在干预前后均接受了溶栓治疗（术后630例）。平均年龄为71岁（标准差为14.6岁），女性为46％。对于按照指南治疗的患者，DNTs从中位值70.0分钟（四分位间距51-93）减少到39.0分钟（四分位间距27-58）（P <0.0001）。从急诊出院的患者比例从45.6％增加到59.5％（P <0.0001）；90天居家时间的中位数从43.3天（四分位间距27.3-55.8）增加到53.6天（四分位间距36.8-64.6）（P = 0.0015）；结论：改善协作可能是降低全省艾伯塔省缺血性卒中患者DNTs和改善结局的关键因素。住院期间死亡率从14.5％降至10.5％（P = 0.0990）。