title: Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.
abstract: In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan.
authors.forename: Fang-I
authors.initials: FI
authors.lastname: Hsieh
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chang-Ming
authors.initials: CM
authors.lastname: Chern
authors.affiliation: Department of Neurology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan.
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Tsai
authors.affiliation: Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan.
authors.forename: Hsun-Hsiang
authors.initials: HH
authors.lastname: Liao
authors.affiliation: Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan.
authors.forename: Hang
authors.initials: H
authors.lastname: Chang
authors.affiliation: RTI International, Waltham, Massachusetts, United States of America.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: LaBresh
authors.affiliation: Taiwan Joint Commission on Hospital Accreditation, Taipei, Taiwan.|Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan.|Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
authors.forename: Hung-Jung
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: School of Public Health, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.|College of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
authors.forename: Hou-Chang
authors.initials: HC
authors.lastname: Chiu
authors.affiliation: Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.|School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Li-Ming
authors.initials: LM
authors.lastname: Lien
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D003299:Cooperative Behavior; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D018794:Problem-Based Learning; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D020521:Stroke / Q000150:complications / Q000628:therapy*; D013624:Taiwan; D015912:Thrombolytic Therapy