Intervention improves use of evidence-based therapies in stroke

A quality improvement intervention increased adherence to evidence-based therapies for patients treated in stroke units, according to new data from the BRIDGE STROKE study.

In the initial results of the cluster-randomized BRIDGE STROKE study presented at the American Heart Association Scientific Sessions in November, the intervention was associated with a twofold increase in adherence to quality measures and a favorable effect on patients treated in hospitals with stroke units.

For the present analysis, researchers analyzed the 814 patients from 17 centers in Argentina, Brazil and Peru that had a stroke unit. M. Julia Machline-Carrion, MD, MHS, PhD, clinical trialist from Hospital for the Heart, Sao Paulo, presented the findings at the International Stroke Conference.

“Despite the established efficacy of several interventions for the management of patients with acute ischemic stroke and transient ischemic attack, the uptake of evidence-based measures remains suboptimal, especially in low- and middle-income countries,” she said during a presentation.

The intervention consisted of a patient identification system, including a colored wristband and printed reminders, an algorithm for care management, including recommendation of evidence-based therapies, nurse case managers to ensure use of the intervention, educational materials with evidence-based recommendations and periodic feedback reports on adherence.

In the intervention group (n = 459; 10 centers), 54% of patients were men and the mean age was 70 years. In the control group (n = 355; seven centers), 62% of patients were men and the mean age was 69 years.

The composite adherence score was 90.6% in the intervention group and 77.5% in the control group (mean difference, 11.35; 95% CI, 3.32-19.37) and the achievement of complete adherence to in-hospital quality measures was higher in the intervention group (59.7% vs. 23.1%; OR = 5.53; 95% CI, 2.07-14.81), Machline-Carrion said.

Patients in the intervention group were more likely than those in the control group to receive tissue plasminogen activator within the therapeutic window (OR = 2.32; 95% CI, 1.06-5.11), to receive dysphagia screening (OR = 13.78; 95% CI, 2.78-68.41), to receive smoking cessation education (OR = 7.08; 95% CI, 2.32-21.55) and to be assessed for rehabilitation (OR = 8.41; 95% CI, 2.15-32.96), according to the researchers.

There were no significant differences between the groups in in-hospital or 90-day clinical events.

“This study identified that this multifaceted quality improvement intervention was effective and workable in hospitals with stroke units in Latin America to increase hospital personnel adherence to evidence-based stroke care,” Machline-Carrion said during the presentation. “Further research is needed to understand the generalizability of these findings to other clinical settings and to the translation of the care process measures improvement into decreased rates of new vascular events.” – by Erik Swain

Disclosure: Machline-Carrion reports she received a research grant from Amgen and consultant/advisory board fees from Boehringer Ingelheim.