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Objective:To understand main problems existing in the construction of advanced stroke centers in China and put forward solutions, for reference in promoting the standardization construction of advanced stroke centers and improving the efficiency of acute stroke treatment.Methods:The data were derived from relevant data of on-site export guidance in the construction of advanced stroke centers at 175 tertiary hospitals from 2020 to 2021, and the scores of on-site evaluation indicators for the establishment of stroke centers and their formal approval were compared and analyzed. Based on on-site investigation and expert consultation, the common problems existing in the construction of advanced stroke centers were summarized. All data were analyzed by descriptive analysis, the scores of on-site evaluation indicators were expressed by ± s, and paired t test was used for comparison between groups. Results:Compared with the total score(693.04±72.06) of on-site evaluation at the stage of project launch, the total score(747.94±78.10) of on-site evaluation for formal approval of stroke centers of 70 hospitals was higher, and the difference was significant( P<0.01). There were seven common problems in the construction of stroke centers in 175 hospitals, including insufficient attention paid by hospitals, lack of effective performance incentive policies, imperfect treatment procedures and medical norms, and so on. Conclusions:Experts on-site guidance plays an important role in the construction of stroke centers in China. At present, there were still problems to tackle in the construction of stroke centers in hospitals. In order to promote the standardized construction of stroke centers in China and improve the efficiency of stroke treatment, the authors suggest fuorther strengthening the importance attached by hospital leadership and the coordination and organization of functional departments, establishing stroke center models conforming to the actual situation of the hospital, seting up the post of brain and heart health manager, and improving the regional prevention and treatment level of acute stroke.
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Stroke is one of the main causes of mortality, long-term physical and cognitive impairment in China. In order to meet the challenge, Stroke Prevention and Treatment Project of the National Health Commission(SPTPC) was established in April 2011 in the Ministry of Health. In 2016, SPTPC issued a work plan of stroke center hospital. In order to shorten the time of pre-hospital, the SPTPC established the stroke center network, stroke map and stroke green channel to create "the three 1-hour gold rescue circle" to form a hierarchical stroke diagnosis and treatment system. The current construction of the Chinese Stroke Center is divided into two levels and four layers. As of December 31, 2018, SPTPC has certified a total of 310 advanced stroke centers, including 30 demonstration advanced stroke centers and 280 advanced stroke centers, and 127 stroke prevention centers, including 85 demonstration stroke prevention centers and 42 stroke prevention centers. The median time from admission to intravenous thrombolysis (DNT) at the advanced stroke center was decreased by 13.2% (53 min vs. 46 min) in the fourth quarter of 2018 as compared with that in the first quarter of 2017.The national thrombolytic rate of acute ischemic stroke was increased 3.24 times (1.78% vs. 0.42%) in 2017 compared that in 2010. In the next step, SPTPC will vigorously promote the construction of stroke centers and graded diagnosis and treatment mechanisms, consolidate quality control and standardization, increase the scope of influence of mobile stroke and remote diagnosis and treatment, and further improve the construction of stroke center systems with Chinese characteristics.
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Stroke is one of the main causes of mortality, long-term physical and cognitive impairment in China. In order to meet the challenge, Stroke Prevention and Treatment Project of the National Health Commission (SPTPC) was established in April 2011 in the Ministry of Health. In 2016, SPTPC issued a work plan of stroke center hospital. In order to shorten the time of pre-hospital, the SPTPC established the stroke center network, stroke map and stroke green channel to create "the three 1-hour gold rescue circle" to form a hierarchical stroke diagnosis and treatment system. The current construction of the Chinese Stroke Center is divided into two levels and four layers. As of December 31, 2018, SPTPC has certified a total of 310 advanced stroke centers, including 30 demonstration advanced stroke centers and 280 advanced stroke centers, and 127 stroke prevention centers, including 85 demonstration stroke prevention centers and 42 stroke prevention centers. The median time from admission to intravenous thrombolysis (DNT) at the advanced stroke center was decreased by 13.2％ (53 min vs. 46 min) in the fourth quarter of 2018 as compared with that in the first quarter of 2017.The national thrombolytic rate of acute ischemic stroke was increased 3.24 times (1.78％ vs. 0.42％) in 2017 compared that in 2010. In the next step, SPTPC will vigorously promote the construction of stroke centers and graded diagnosis and treatment mechanisms, consolidate quality control and standardization, increase the scope of influence of mobile stroke and remote diagnosis and treatment, and further improve the construction of stroke center systems with Chinese characteristics.
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Stroke is the first cause of death in China, with high disability and causing serious economic burden to the society and families. Moreover it is one of the most important reasons for returning to poverty due to illness. Investigation shows that the awareness of active treatment and control for various risk factors of cerebrovascular disease is increasing in China. With the development of stroke diagnosis and treatment technology, the mortality of patients with severe stroke is reducing. However, there is still a long way to go to curb the rapid increase of stroke incidence and to reduce the mortality of stroke.
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Objective To discuss the impacts of stroke center construction upon therapeutic indexes for di-agnosing and treating patients with acute ischemic stroke. Methods Patients were divided into a control group (180 patients)and a formal group(245 patients)based on the time of stroke center construction.Patients in both groups were recorded time points in the course of diagnosis and treatment,and compared in number of cases with intravenous thrombolysis,number of cases receiving intravascular interventional therapies,DTN(door-to-needle) time,number of deaths,National Institutes of Health Stroke Scale(NIHSS)scores upon grouping,NIHSS scores after four weeks,NIHSS scores after 3 months,days of hospital stay and hospital charges.Results After the con-struction of the stroke center,time spent in different links were decreased.The number of cases with pure intrave-nous thrombolysis and DTN time(shorter than 60 min)were increased,and the difference were statistically signifi-cant(P<0.01).The number of cases who only received intravascular interventional therapies is increased,mean-while,DTN time was decreased,NIHSS scores after 4 weeks was increased and NIHSS scores after 3 months were also increased(P < 0.05)in these cases. No statistically significant differences existed in number of cases who were treated by bridging with intravenous thrombolysis in combination with intravascular interventional therapies and death cases(P=0.153,P=0.247).There were no statistically significant differences in days of hospital stay and hospital charges(P=0.152,P=0.406).Conclusions After the stroke center construction,it is helpful for significantly improving medical institutions′diagnosis and treatment of stroke,reducing time of such diagnosis and treatment in different links,shortening DTN time,increasing thrombolysis rate,improving patients′prognosis and bringing more benefits to patients with acute ischemic stroke by optimizing procedures for diagnosing and treating stroke.
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BACKGROUND: The patients who received organized inpatient care are more likely to survive and to be independent. The benefit is most apparent in units based in a discrete ward, stroke unit (SU). The observed benefit is sufficiently large to warrant efforts of widespread implementation of SU care. The Korean Stroke Society surveyed acute stroke care hospitals to know the density and the distribution of SU in Korea. METHODS: One hundred-sixty one acute care hospitals were selected among those included in the 5th Quality Audit in 2014 by the Health Insurance Review and Assessment Service of Korea. A senior director of stroke service in each hospital was chosen and asked about the current status of acute stroke care including SU and major obstacles to establish SU in each hospital. RESULTS: The results of the questionnaire revealed the shortage of a total SU number and markedly uneven distribution of SU between rural and urban area. Most hospitals indicated the absence of the insurance reimbursement for medical service in SU, which served as the fundamental cause of lack of skilled manpower for establishing SU. CONCLUSIONS: The state-of-the-art SU, which is properly certified or designated, should be spread out more evenly in Korea for the optimal treatment of public regardless of a residential district. Government should encourage and support for the establishment of SU, which is an important first step toward making it reality.
Subject(s)
Humans , Inpatients , Insurance , Insurance, Health , Korea , StrokeABSTRACT
BACKGROUND: The patients who received organized inpatient care are more likely to survive and to be independent. The benefit is most apparent in units based in a discrete ward, stroke unit (SU). The observed benefit is sufficiently large to warrant efforts of widespread implementation of SU care. The Korean Stroke Society surveyed acute stroke care hospitals to know the density and the distribution of SU in Korea. METHODS: One hundred-sixty one acute care hospitals were selected among those included in the 5th Quality Audit in 2014 by the Health Insurance Review and Assessment Service of Korea. A senior director of stroke service in each hospital was chosen and asked about the current status of acute stroke care including SU and major obstacles to establish SU in each hospital. RESULTS: The results of the questionnaire revealed the shortage of a total SU number and markedly uneven distribution of SU between rural and urban area. Most hospitals indicated the absence of the insurance reimbursement for medical service in SU, which served as the fundamental cause of lack of skilled manpower for establishing SU. CONCLUSIONS: The state-of-the-art SU, which is properly certified or designated, should be spread out more evenly in Korea for the optimal treatment of public regardless of a residential district. Government should encourage and support for the establishment of SU, which is an important first step toward making it reality.
Subject(s)
Humans , Inpatients , Insurance , Insurance, Health , Korea , StrokeABSTRACT
Objective To discuss the practice of nursing management model of stroke unit based upon the international standards implemented in the neurological unit.Methods The experiences of the stroke unit management were summarized and applied to instruct the clinical practice.Results After the implementation,the average hospitalization days,the proportion of drugs,medical cost,and mortality rate decreased.The satisfactory degree of patients with the stroke unit increased.Conclusions The nursing management model of stroke unit not only improved the quality of nursing service to stroke patients,but also decreases the mortality and disability rate,shortened the length of hospital stay,and enhanced the satisfaction degree of patients and their family members.
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BACKGROUND AND PURPOSE: Organized inpatient stroke care is one of the most effective therapies for improving patient outcomes. Many stroke centers have been established to meet this need, however, there are limited data on the effectiveness of these organized comprehensive stroke center (CSC) in the real-world setting. Our aim is to determine whether inpatient care following the establishment of CSC lowers mortality of patients with acute ischemic stroke (AIS). METHODS: Based on a prospective stroke registry, we identified AIS patients hospitalized before and after the establishment of a CSC. We observed all-cause mortality within 30 days from time of admission. Logistic regression was used to determine whether the establishment of the CSC affects independently the 30-day all-cause mortality. RESULTS: A total of 3,117 consecutive patients with AIS were admitted within seven days after the onset of the symptoms. Unadjusted 30-day mortality was lower for patients admitted to our hospital after the establishment of the CSC than before (5.9% vs. 8.2%, P=0.012). Advanced age, female gender, previous coronary artery disease, non-smoking, stroke subtype, admission on a holiday, referral from other hospitals, high NIHSS on admission, and admission before the establishment of CSC were associated with increased 30-day stroke case fatality. After adjustment for these factors, stroke inpatient care subsequent to the establishment of the CSC was independently associated with lower 30-day mortality (OR, 0.57; 95% CI, 0.412-0.795). CONCLUSIONS: Patients treated after the establishment of a CSC had lower 30-mortality rates than ever before, even adjusting for the differences in the baseline characteristics. The present study reveals that organized stroke care in a CSC might improve the outcome after AIS.
Subject(s)
Female , Humans , Coronary Artery Disease , Holidays , Inpatients , Logistic Models , Prospective Studies , Referral and Consultation , StrokeABSTRACT
In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center.
Subject(s)
Brain , Certification , Health Services , Heart , Joints , Quality Improvement , Stroke , Tissue Plasminogen Activator , United States , Wit and Humor as TopicABSTRACT
The acute management of ischemic stroke consists of several components: general supportive care, thrombolysis, antithrombotics, prevention of medical and neurologic complications, rehabilitation, and if necessary, surgical intervention. However, for the adequate stroke care, not only the medical treatment but also the proper organization of each stroke care component is essential. This includes public education, well organized emergency medical referral system, pre-hospital identification tool of stroke, operation of stroke unit with quality improvement activity, and establishment of stroke center. The efficacy of stroke unit for the acute management of stroke was found to exceed those of conventional medical treatment such as antiplatelet therapy, and now stroke unit is considered to be the key element of acute stroke care. For the harmonious orchestration of these stroke care elements, there is growing need for the establishment of stroke center too. In this review, each component of stroke care is discussed.