Adherence to Stroke Care Performance Measures in Different Regions in China, 2015-2019: Evidence From the Chinese Stroke Center Alliance.

BACKGROUND AND OBJECTIVES: To explore the regional discrepancy of the adherence to guideline-recommended stroke interventions for the stroke belt division (north vs south), the economic development division (east vs middle vs west), and potential interaction. METHODS: We conducted a retrospective observational study using data from the Chinese Stroke Center Alliance from August 2015 to August 2019. The primary outcome was hospital personnel adherence to 11 individual guideline-recommended treatments. The coprimary outcomes included 2 summary measures: a composite score (range, 0 [nonadherence] to 1 [perfect adherence]) and an all-or-none binary outcome for adherence to evidence-based stroke. Regional disparities were assessed according to the stroke belt division and the economic development division and the interaction between these 2 divisions. Multivariate regression models with generalized estimating equations were used to analyze the outcomes. RESULTS: This study included 838,229 patients with acute ischemic stroke from 1,473 hospitals. The overall quality of care in the nonbelt regions (southern China) was higher than in the stroke belt regions (northern China), as reflected by a higher composite score (0.77 vs 0.75; adjusted odds ratio 1.03 [95% CI 1.02-1.04]; p < 0.001) and a higher all-or-none measure (25.5% vs 22.0%; 1.32 [1.17-1.49], p < 0.001). Patients in the East and Central had higher odds of using intravenous tissue-type plasminogen activator (East: 1.81 [95% CI 1.51-2.18], p < 0.001; Central: 1.57 [95% CI 1.26-1.95], p < 0.001), early antithrombotic medications (East: 1.77 [1.49-2.11], p < 0.001; Central: 1.37 [1.12-1.66], p < 0.001), lipid-lowering medications (East: 1.29 [1.08-1.53], p < 0.001), and deep vein thrombosis prophylaxis (East: 1.28 [1.08-1.50], p = 0.003) compared with those in the West. Patients in the nonbelt regions had higher odds of getting dysphagia screening (1.82 [1.55-2.13], p < 0.001) and rehabilitation assessment (which though varied among different economic development levels). Reflected by significant interaction effects, for patients in the East, those in the nonbelt regions had greater odds of receiving anticoagulation (1.62 [1.34-1.96]; p < 0.001) but lower odds of receiving antithrombotic (0.63 [0.52-0.77]; p < 0.001) and antidiabetic medications (0.87 [0.77-0.99]; p = 0.03); for patients in the West, those in the nonbelt regions were less likely to receive antihypertensive (0.64 [0.46-0.88]; p = 0.004) and antidiabetic (0.66 [0.54-0.81]; p < 0.001) medications. DISCUSSION: Stroke care performance measures differed across regions, along the stroke belt division, and the economic development division. The overall quality of care in the non-stroke belt regions was higher than that in the stroke belt regions. The 2 divisions had interaction effects on several individual measures.

GRP per capita and hospital characteristics associated with intravenous tissue plasminogen activator adherence rate: evidence from the Chinese Stroke Center Alliance.

BACKGROUND: Timely delivery of intravenous tissue plasminogen activator (IV-rt PA) is pivotal to eligible patients who had a stroke while achieving higher rates of IV-rt PA has been problematic. This paper focuses on investigating influential factors associated with the administration of IV-rt PA, primarily per capita gross regional product (GRP) and healthcare system factors. METHODS: The study included 980 hospitals in the Chinese Stroke Center Alliance where 158 003 patients who had an acute ischaemic stroke received IV-rt PA between August 2015 and August 2019. The adherence rate to IV-rt PA within 4.5 hours time window in each hospital was the primary outcome. Influential factors were grouped into two categories: macroeconomic status and hospital characteristics. The outcome was analysed using multivariable linear regression. RESULTS: GRP per capita (ß=2.37, p<0.001), hospital stroke centre certification (ß=3.77, p<0.001), number of neurologists (ß=0.12, p<0.001), existence of emergency services for neurological treatment (ß=7.43, p=0.014), presence of emergency department (ß=10.03, p=0.019) and cooperating with emergency centre (ß=4.65, p=0.029) were significantly positively associated with the adherence rate to IV-rt PA. CONCLUSIONS: Higher GRP per capita, affluent neurological personnel, well-equipped emergency services for neurological treatment and routine cooperation with the emergency centre were important for enhancing the adherence rate to IV-rt PA among patients who had an acute ischaemic stroke in China.