Comparison Between Healthcare Quality in Primary Stroke Centers and Comprehensive Stroke Centers for Acute Stroke Patients: Evidence from the Chinese Stroke Center Alliance

Overview

Journal Lancet Reg Health West Pac

Date 2023 Aug 14

PMID 37577368

Authors

Zeyu Liu

Hongqiu Gu

Minping Wei

Xianjing Feng

Fang Yu

Jie Feng

Zixiao Li

Jian Xia

Xin Yang

Affiliations

Soon will be listed here.

Abstract

Background: To improve stroke care quality, the guidelines for stroke center construction in China recommended establishing primary stroke centers (PSCs) and comprehensive stroke centers (CSCs). We aimed to compare stroke care quality between the two types of centers.

Methods: Data were collected from acute stroke patients admitted to PSCs or CSCs in the China Stroke Center Alliance program. Twenty-one individual guideline-recommended performance measures and two summary measures were compared between the two groups. Multivariable logistic regression models were used to examine the association between stroke center status (CSC vs. PSC) and healthcare quality.

Findings: Data from 750,594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. For many components of healthcare performance in stroke patients, comparable levels of performance were observed between CSCs and PCSs. Nonetheless, CSCs outperformed PSCs in the areas of administering intravenous recombinant tissue plasminogen activator within 4.5 h (aOR = 1.31 [95% CI: 1.07-1.60]), rehabilitation for acute ischaemic stroke (AIS) (aOR = 1.19 [95% CI: 1.01-1.40]), and the provision of hypoglycemic medication and statin therapy upon discharge for AIS (aOR = 1.26 [95% CI: 1.00-1.59] and aOR = 1.28 [95% CI: 1.04-1.59], respectively). More patients with intracerebral haemorrhage and subarachnoid haemorrhage received neurosurgery in CSCs (14.4% vs. 10.6% and 51.0% vs. 33.9%, respectively). Additionally, CSCs had higher in-hospital mortality than PSCs (aOR = 1.33 [95% CI: 1.01-1.73]).

Interpretation: Overall PSCs provided equivalent care for many quality measures to CSCs in China with the exception of thrombolysis, rehabilitation access, and medication at discharge for AIS, whereby improvements should be directed. Nevertheless, PSCs have demonstrated lower risk-adjusted in-hospital mortality rates.

Funding: The National Key Research and Development Projects of China.

Citing Articles

Deep Learning-Based Automatic Classification of Ischemic Stroke Subtype Using Diffusion-Weighted Images.

Ryu W, Schellingerhout D, Lee H, Lee K, Kim C, Kim B J Stroke. 2024; 26(2):300-311.

PMID: 38836277 PMC: 11164582. DOI: 10.5853/jos.2024.00535.

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