Associations Between Adherence to Evidence-Based, Stroke Quality Indicators and Outcomes of Acute Reperfusion Therapy

医学冲程（发动机）优势比血运重建逻辑回归病历急诊医学可能性内科学

作者

Nice Ren,Soshiro Ogata,Eri Kiyoshige,Kunihiro Nishimura,Ataru Nishimura,Ryu Matsuo,Takanari Kitazono,Takahiro Higashi,Kuniaki Ogasawara,Koji Iihara,Takashi Shimizu,Isao Sasaki,Junta Moroi,Hiroaki Shimizu,Minoru Asahi,Makoto Goda,Kensuke Murakami,Takamasa Mizuno,Ryougo Anei,Yukihide Kanemoto,Ryunosuke Uranishi,Yutaka Shimoe,Yorio Koguchi,Kenji Wakui,Atsushi Fujikawa,Junichiro Kumai,Yasushi Ejima,Hayashi Satoru,Isao Chokyu,Tatuya Singaki,Toshikazu Ichihasi,Takayuki Kato,Masamichi Kurosaki,Yukihiko Fujii,Tomonori Kobayashi,Satoshi Fujiwara,Keiji Fukui,Hideo Kunimine,Satoshi Taira,Ichiro Nakahara,Syogo Imae,Masanori Kabuto,Noritaka Sano,Toshio Higashi,Hiroshi Abe,Kei Harada,Naoko Fujimura,Tani Masaharu,Kin Shigenari,Kiyoshi Saito,Yoichi Watanabe,Tetsuya Tanigawara,Toru Iwama,Oki Yoshiharu,Ichiro Suzuki,Toshinari Misaki,Yoshihisa Maeda,Takaaki Yamazaki,Koichi Haraguchi,Shuji Hayashi,Teiji Nakayama,Koichiro Matsukado,Akio Nishino,Tadahisa Shono,Hideki Doi,Takatoshi Fujimoto,Naofumi Isono,Shouhei Kimura,Naoyuki Kakuda,Fumiaki Isaka,Hiroki Ohkuma,Atushi Tominaga,Masayuki Sumida,Kaoru Kurisu,Naoki Shinohara,Naoki Nakayama,Toshiyuki Uehara,Shinichi Yoshimura,Yoshio Sakagami,Takayuki Sakaki,Keishi Fujita,Sumio Kobayashi,Yoshihiro Natori,Kousyou Fujikawa,Nobuaki Momozaki,Atsushi Sato,Kazunori Akaji,Fumitaka Miya,Shibano Katsuhiko,Yutaka Hayashi,Tsuyoshi Inoue,Naohisa Miura,Masatou Kawashima,Naoto Kimura,Kazuyuki Miura,Jun Sugata,Masato Seike,Naoyuki Isobe,Naoyuki Imamoto,Hirofumi Hiyama,Akira Ikeda,Yasuyuki Hitoshi,Katsumi Takizawa,Jiro Kitayama,Takanori Oikawa,Teruo Kimura,Terasaki Tadashi,Hiroki Fukuda,Syuntaro Takasu,Michio Nakamura,Yasuhiro Hamada,Fuminori Iwamoto,Kawai Kensuke,Naoki Shirasaki,Kimihiro Yoshino,Takashi Tamiya,Hiroshi Tokimura,Koji Yoshimoto,Fumiaki Katada,Takaaki Iida,Fujimoto Yasuhiro,Akio Asai,Takuyu Taki,Katsuhiko Maruichi,Hiromasa Yamamoto,Naoaki Sato,Katoh Hiroshi,Mizuya Shinoyama,Toshiho Ohtsuki,Ryuhei Kouno,Satoshi Magarisawa,Junya Taki,Hirotoshi Hamaguchi,Idei Masaru,Haruhisa Tsukamoto,Eiitiro Kamatuka,Toshihiro Kumabe,Nobuyuki Sakai,Kazuya Nakashima,Yoshie Hara,Eiji Kohmura,Kohkichi Hosoda,Naoki Fukui,Hiyoruki Nishimura,Yukako Yazawa,Masaomi Koyanagi,Toshinori Hasegawa,Hisashi Nitta,Nobutake Sadamasa,Fujiwara Kenjiro,Akihiko Kaga,Takuya Kawai,Kouichirou Komatsubara,Masaki Chin,Kensaku Shibasaki,Ohmori Shigehiro,Masaki Ito,Hiroshi Sakaida,Teruyuki Hirano,Masayuki Yokota,Mamoru Murakami,Keisuke Imai,Tatsuhito Yamagami,Minoru Kidooka,Toshiki Mizuno,Susumu Miyamoto,Norio Nakajima,Hitonori Takaba,Sei Haga,Takeru Umemura,Koichi Arimura,Masahito Agawa,Ken Asakura,Arai Yoshinori,Tsukada Toshiyuki,Naoki Sato,Ryukichi Matsui,Toshikazu Takeshima,Yotaro Takeuchi,Motohiro Arai,Fujimaro Ishida,Hidenori Suzuki,Takahiro Murata,Hisashi Tanaka,Yoichi Harada,Yasushi Shibata,Tetsuya Masaoka,Shunro Uchinokura,Osamu Hamasaki,Akihito Moriki,Misao Nishikawa,Naohiko Kubo,Yosimasa Kinoshita,Kazuki Wakabayashi,Daiki Murata,Hiroshi Ooyama,Satoshi Horiguchi,Yoshikazu Kusano,Yoshinori Taniguchi,Tsuyoshi Izumo,Hideki Kanai,Mitsuhito Mase,Toshihiko Wakabayashi,Noki Tomiyama,Ryo Doi,Nobuto Murakami,Hiromichi Koga,Hidemori Tokunaga,Masato Inoue,Masatoshi Koga,Yasuyuki Nagai,Keigo Shigea,Junya Kuroda,Ken Kazumata,Yamashita Katsuhiro,Takeshi Takamoto,Shunichi Fukuda,Tomonori Yamada,Kotaro Ogihara,Tokumitsu Naoki,Masayuki Ezura,Hideki Sakai,Atsuo Yoshino,Ken-Ichi Morita,Kiyoshi Onda,Shigeta Moriya,Yoshitaka Yamada,Hideki Sawa,Yasunari Otawara,Daisuke Kita,Masanobu Yamada,Norihiko Akao,Souichi Obara,Haruki Takahashi,Masafumi Ohtaki,Naoya Shimada,Katsuhiko Hayashi,Yoshihiro Kuga,Masahisa Kawakaki,Toshihisa Nakano,Koji Tokunaga,Sanami Kawada,Yoshiaki Adachi,Isao Date,Koji Idomari,Tomoaki Nagamine,Masayuki Nakajima,Akira Isoshima,Terukazu Kuramoto,Tomoya Ishiguro,Masahiko Wanibuchi,Akatsuki Wakayama,Naoki Hayashi,Hiroyuki Hashimoto,Hideki Mochizuki,Masaaki Saiki,Nishihara Jun,Kenji Hashimoto,Takeshi Uwatoko,Abe Tatsuya,Osamu Nishizaki,Toshiro Katsuta,Toshiro Yonehara,Miyamoto Junichi,Hiroto Murata,Gohei So,Michiya Kubo,Kazuhiro Tomiyasu,Mitsuhiro Ogura,Yuji Okamoto,Makoto Inaba,Atsuhiro Kojima,Hiroki Kurita,Kyoichi Nomura,Toshie Takahashi,Yoshikazu Nakajima,Yoshida Takaaki,Atsushi Fukuma,Tadashi Nakagawa,Yohei Kudoh,Toshitaka Nakamura,Nobuhiro Mikuni,Tadashi Nonaka,Rokuya Tanikawa,Takemoto Kouichirou,Yoshinari Okumura,Akiyoshi Sato,Souichi Akamine,Karibe Hirosi,Masato Hojo,Kazuhiko Nozaki,Masaaki Korai,Shigeru Yamauchi,Fusao Ikawa,Yasuhiko Akiyama,Kimitoshi Sato,Tsutomu Hitotsumatsu,Jinichi Sasanuma,Jun-Ichi Koyama,Makoto Ichinose,Seiji Fukazawa,Kazuhiro Yoshioka,Muraoka Sinsuke,Masaru Honda,Tsuneo Shishido,Kenji Kamiyama,Akihiro Fujii,Yasunobu Gotou,Toshinari Arai,Hiroaki Arai,Zenitirou Watanabe,Yasunari Niimi,Yasuhiro Hasegawa,Eiji Imamura,Yukinari Kakizawa,Tomohiro Araki,Tetuya Morimoro,Shinya Okita,Takaaki Inomoto,Eiichirou Mabuchi,Yanagihara Takehiko,Shin Gotou,Hiroshi Abe,Akira Matsuno,Hirofumi Nakatomi,Teiji Tominaga,Hideomi Kitajima,Hiromi Ueta,Takagi Yasushi,Harada Kunihiko,Sadao Suga,Junya Tsurukiri,Kouichi Kato,Haruhiko Hoshino,Kazuo Kitagawa,Takeda Yasuaki,Yoshiki Obata,Tomohiro Yamauchi,Keiichirou Onitsuka,Masahiko Kitano,Jaehyun Son,Toru Masuoka,Hiroyuki Yuasa,Keiichi Akatsuka,Satoshi Kuroda,Itou Masashi,Takayuki Watanabe,Yusuke Okamura,Motoki Oheda,Yamamoto Shinji,Taichiro Kawakami,Go Ikeda,Hiroshi Maruya,Kazuki Kobayashi,Norio Ikeda,Nozomu Murai,Osamu Yamamura,Hajime Ohta,Junkoh Yamamoto,Yuji Matsumaru,Hiroyuki Kinouchi,Masayuki Miyazono,Ozawa Hitoshi,Daisuke Syoda,Koji Yamasaki,Naoyuki Nakao,Daiji Ogawa,Seiya Takehara,Rei Kondo,Takashi Kumagai,Sonoda Yukihiko,Manabu Urakawa,Michiyasu Suzuki,Yasunobu Mita,Uchida Mikito,Nakano Shin,Hiroshi Ozawa,Naoyuki Sakai,Hiroaki Tanaka,Masafumi Morimoto,Kisi Hirohisa,Yoichi Yoshida,Yasuhisa Yoshida

出处

期刊：Stroke [Ovid Technologies (Wolters Kluwer)]
日期：2022-08-16

标识

DOI：10.1161/strokeaha.121.038483

摘要

Background: Quality indicators (QIs) are an accepted tool for measuring a hospital’s performance in routine care. We examined national trends in adherence to the QIs developed by the Close The Gap-Stroke program by combining data from the health insurance claims database and electronic medical records, and the association between adherence to these QIs and early outcomes in patients with acute ischemic stroke in Japan. Methods: In the present study, patients with acute ischemic stroke who received acute reperfusion therapy in 351 Close The Gap-Stroke-participating hospitals were analyzed retrospectively. The primary outcomes were changes in trends for adherence to the defined QIs by difference-in-difference analysis and the effects of adherence to distinct QIs on in-hospital outcomes at the individual level. A mixed logistic regression model was adjusted for patient and hospital characteristics (eg, age, sex, number of beds) and hospital units as random effects. Results: Between 2013 and 2017, 21 651 patients (median age, 77 years; 43.0% female) were assessed. Of the 25 defined measures, marked and sustainable improvement in the adherence rates was observed for door-to-needle time, door-to-puncture time, proper use of endovascular thrombectomy, and successful revascularization. The in-hospital mortality rate was 11.6%. Adherence to 14 QIs lowered the odds of in-hospital mortality (odds ratio [95% CI], door-to-needle <60 min, 0.80 [0.69–0.93], door-to-puncture <90 min, 0.80 [0.67–0.96], successful revascularization, 0.40 [0.34–0.48]), and adherence to 11 QIs increased the odds of functional independence (modified Rankin Scale score 0–2) at discharge. Conclusions: We demonstrated national marked and sustainable improvement in adherence to door-to-needle time, door-to-puncture time, and successful reperfusion from 2013 to 2017 in Japan in patients with acute ischemic stroke. Adhering to the key QIs substantially affected in-hospital outcomes, underlining the importance of monitoring the quality of care using evidence-based QIs and the nationwide Close The Gap-Stroke program.

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Associations Between Adherence to Evidence-Based, Stroke Quality Indicators and Outcomes of Acute Reperfusion Therapy

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