Chinese Stroke Center Alliance: a National Effort to Improve Healthcare Quality for Acute Stroke and Transient Ischaemic Attack: Rationale, Design and Preliminary Findings

Overview

Journal Stroke Vasc Neurol

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 15

PMID 30637133

Citations 59

Authors

Yongjun Wang

Zixiao Li

Yilong Wang

Xingquan Zhao

Liping Liu

Xin Yang

Caiyun Wang

Hongqiu Gu

Fuying Zhang

Chunjuan Wang

Ying Xian

David Z Wang

Qiang Dong

Anding Xu

Jizong Zhao

Affiliations

Soon will be listed here.

Abstract

Background: In June 2015, the Chinese Stroke Association (CSA) initiated the Chinese Stroke Center Alliance (CSCA) to establish the national hospital-based stroke care quality assessment and improvement platform. This article outlines its objectives, operational structure, patient population, quality improvement (QI) intervention tools, data elements, data collection methodology and current patient and hospital data.

Methods: The CSCA is a national, hospital-based, multicentre, voluntary, multifaceted intervention and continuous QI initiative. This multifaceted intervention includes stroke centre development, written care protocols, workshops and a monitoring/feedback system of evidence-based performance measures. The data coordinating centre of the CSCA resides at the China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital.

Results: As of July 2017, 1576 hospitals in China have contributed detailed clinical information to serve as a benchmark for the stroke care quality of 433 264 patients with acute stroke/transient ischaemic attacks (TIA), including 352 572 (81.38%) acute ischaemic stroke, 30 362 (7.01%) TIA, 42 080 (9.71%) spontaneous intracranial haemorrhage, 5505 (1.27%) subarachnoid haemorrhage and 2745 (0.63%) not specified stroke.

Conclusion: The CSCA programme is designed to establish a continuous national stroke registry and help healthcare providers develop stroke centres and treat patients in a consistent manner in accordance with accepted national guidelines and, ultimately, improve patient outcomes. It supports the CSA mission to reduce stroke burden in China.

Citing Articles

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A systematic review of current national hospital-based stroke registries monitoring access to evidence-based care and patient outcomes.

Leigh C, Gill J, Razak Z, Shreyan S, Cadilhac D, Kim J Eur Stroke J. 2025; 23969873241311821.

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References

Cabana M, Rand C, Powe N, Wu A, Wilson M, Abboud P . Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999; 282(15):1458-65. DOI: 10.1001/jama.282.15.1458. View

Schwamm L, Fonarow G, Reeves M, Pan W, Frankel M, Smith E . Get With the Guidelines-Stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2008; 119(1):107-15. DOI: 10.1161/CIRCULATIONAHA.108.783688. View

Peterson E, Roe M, Rumsfeld J, Shaw R, Brindis R, Fonarow G . A call to ACTION (acute coronary treatment and intervention outcomes network): a national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2009; 2(5):491-9. DOI: 10.1161/CIRCOUTCOMES.108.847145. View

Xian Y, Holloway R, Chan P, Noyes K, Shah M, Ting H . Association between stroke center hospitalization for acute ischemic stroke and mortality. JAMA. 2011; 305(4):373-80. PMC: 3290863. DOI: 10.1001/jama.2011.22. View

Liu L, Wang D, Wong K, Wang Y . Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011; 42(12):3651-4. DOI: 10.1161/STROKEAHA.111.635755. View

Dong Q, Gao S, Huang R, Huang Y, Lv C, Liu M . Chinese guidelines for the secondary prevention of ischemic stroke and transient ischemic attack 2010. CNS Neurosci Ther. 2012; 18(2):93-101. PMC: 6493434. DOI: 10.1111/j.1755-5949.2011.00290.x. View

Wang Y, Wang Y, Zhao X, Liu L, Wang D, Wang C . Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013; 369(1):11-9. DOI: 10.1056/NEJMoa1215340. View

Zhang B, Zhai F, Du S, Popkin B . The China Health and Nutrition Survey, 1989-2011. Obes Rev. 2013; 15 Suppl 1:2-7. PMC: 3869031. DOI: 10.1111/obr.12119. View

Feigin V, Forouzanfar M, Krishnamurthi R, Mensah G, Connor M, Bennett D . Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383(9913):245-54. PMC: 4181600. DOI: 10.1016/s0140-6736(13)61953-4. View

10.

Fonarow G, Zhao X, Smith E, Saver J, Reeves M, Bhatt D . Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014; 311(16):1632-40. DOI: 10.1001/jama.2014.3203. View

11.

Yu H . Universal health insurance coverage for 1.3 billion people: What accounts for China's success?. Health Policy. 2015; 119(9):1145-52. PMC: 7114832. DOI: 10.1016/j.healthpol.2015.07.008. View

12.

Kroll M, Phalkey R, Kraas F . Challenges to the surveillance of non-communicable diseases--a review of selected approaches. BMC Public Health. 2015; 15:1243. PMC: 4682212. DOI: 10.1186/s12889-015-2570-z. View

13.

Yang X, Li Z, Zhao X, Wang C, Liu L, Wang C . Use of Warfarin at Discharge Among Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation in China. Stroke. 2015; 47(2):464-70. DOI: 10.1161/STROKEAHA.115.011833. View

14.

Li Z, Wang C, Zhao X, Liu L, Wang C, Li H . Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke. 2016; 47(11):2843-2849. DOI: 10.1161/STROKEAHA.116.014143. View

15.

Sherman R, Anderson S, Dal Pan G, Gray G, Gross T, Hunter N . Real-World Evidence - What Is It and What Can It Tell Us?. N Engl J Med. 2016; 375(23):2293-2297. DOI: 10.1056/NEJMsb1609216. View

16.

Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L . Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation. 2017; 135(8):759-771. DOI: 10.1161/CIRCULATIONAHA.116.025250. View

17.

Wang Y, Liu M, Pu C . 2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack. Int J Stroke. 2017; 12(3):302-320. DOI: 10.1177/1747493017694391. View

18.

Wang Y, Li Z, Zhao X, Wang D, Li H, Xian Y . Stroke care quality in China: Substantial improvement, and a huge challenge and opportunity. Int J Stroke. 2017; 12(3):229-235. DOI: 10.1177/1747493017694392. View

19.

Blacquiere D, Lindsay M, Foley N, Taralson C, Alcock S, Balg C . Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017. Int J Stroke. 2017; 12(8):886-895. DOI: 10.1177/1747493017706239. View

20.

Man S, Schold J, Uchino K . Impact of Stroke Center Certification on Mortality After Ischemic Stroke: The Medicare Cohort From 2009 to 2013. Stroke. 2017; 48(9):2527-2533. DOI: 10.1161/STROKEAHA.116.016473. View