Table 2. Effect of a Quality Improvement Intervention on Adherence to Evidence-Based Therapies for Patients With AIS and TIA (Intention-to-Treat Analysis)a.
| End Point | Intervention Groupb | Control Groupc | OR (95% CI) | P Value | ICCd |
|---|---|---|---|---|---|
| Composite adherence score, mean (SD), %e | 85.3 (20.1) | 77.8 (18.4) | 4.2 (−3.8 to 12.2)f | .29 | 0.332 |
| Secondary | |||||
| Acute therapies during first 48 h | |||||
| Intravenous rt-PAg | 122/222 (55.0) | 107/268 (39.9) | 2.77 (1.31 to 5.82) | .01 | 0.169 |
| Global rt-PAh | 145/538 (27.0) | 121/602 (20.1) | 2.07 (1.05 to 4.09) | .04 | 0.173 |
| Rt-PA within 3 hi | 69/123 (56.1) | 47/143 (32.9) | 3.31 (1.33 to 8.23) | .01 | 0.194 |
| Door-to-needle time <60 min | 84/145 (57.9) | 59/121 (48.8) | 2.47 (0.97 to 6.28) | .06 | 0.158 |
| Door-to-needle time <45 min | 59/145 (40.7) | 35/121 (28.9) | 1.86 (0.85 to 4.09) | .12 | 0.037 |
| Early antithrombotics | 759/811 (93.6) | 756/803 (94.1) | 0.59 (0.26 to 1.38) | .22 | 0.183 |
| Prophylaxis for DVT | 326/450 (72.4) | 234/466 (50.2) | 2.56 (0.92 to 7.11) | .07 | 0.375 |
| Dysphagia screening | 577/711 (81.2) | 460/723 (63.6) | 2.82 (0.71 to 11.24) | .14 | 0.547 |
| Discharge therapies | |||||
| Antithrombotics | 751/811 (92.6) | 759/806 (94.2) | 0.59 (0.25 to 1.35) | .21 | 0.211 |
| Oral anticoagulants for atrial fibrillation or flutter | 111/146 (76.0) | 77/97 (79.4) | 1.02 (0.41 to 2.50) | .97 | 0.044 |
| LDL-C level ≥100 mg/dL or not documented | 613/675 (90.8) | 631/701 (90.0) | 0.87 (0.50 to 1.51) | .61 | 0.08 |
| Smoking cessation | 93/129 (72.1) | 82/169 (48.5) | 3.22 (1.05 to 9.88) | .04 | 0.278 |
| Assessed for rehabilitation | 620/711 (87.2) | 574/723 (79.4) | 1.92 (0.58 to 6.33) | .28 | 0.457 |
| Antihypertensives | 479/622 (77.0) | 499/586 (85.2) | 0.69 (0.33 to 1.47) | .34 | 0.213 |
| Complete adherence to all eligible acute and discharge therapiesj | 402/817 (49.2) | 203/807 (25.2) | 2.59 (1.22 to 5.53) | .01 | 0.251 |
Abbreviations: AIS, acute ischemic stroke; DVT, deep venous thrombosis; ICC, intracluster correlation coefficient; LDL-C, low-density lipoprotein cholesterol; OR, odds ratio; rt-PA, recombinant plasminogen activator; TIA, transient ischemic attack.
SI conversion factor: To convert LDL-C to millimoles per liter, multiply by 0.0259.
Unless otherwise indicated, data are presented as number/total number eligible for therapy (percentage).
Includes 19 clusters (hospitals) and 817 patients.
Includes 17 clusters (hospitals) and 807 patients.
Estimated from mixed logistic regression model considering group (intervention and control) adjusted by clusters’ observational phase mean end point.
Indicates primary end point, including early use of antithrombotics, rt-PA within therapeutic window, door-to-needle time of less than 60 minutes, DVT prophylaxis, dysphagia screening, antithrombotics at discharge, anticoagulants for atrial fibrillation or flutter assessment for rehabilitation, statins in patients with LDL-C level of at least 100 mg/dL or not documented, smoking cessation education, and assessment for rehabilitation.
Data shown are mean difference (95% CI).
Indicates within therapeutic window (patients who arrived within 3.5 hours of symptoms onset and were treated within 4.5 hours).
Indicates delivered in patients who arrived within 24 hours of symptoms and had no contraindications.
Indicates patients who arrived within 2 hours of symptoms and were treated within 3 hours.
Includes patients who received all eligible therapies in an all-or-none model.