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多重干预模式对急性缺血性卒中医疗质量改进的整群随机研究

Data:2018-07-05 09:40
Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China
金桥工程研究是一项多中心、整群随机、对照试验,主要研究目的是评价多重干预措施对急性缺血性卒中医疗服务质量改进的影响,同时评估对患者短期和长期结局预后的影响。金桥工程研究结果于2018年6月29日发表于国际顶级医学期刊《美国医学会杂志(JAMA)》,是美国医学会杂志发表的重要的卒中医疗质量整群随机干预研究,促进卒中医疗质量改进在卒中管理中的作用。
研究证实多重质量改进干预工具和质量反馈可改进缺血性卒中医疗服务质量,支持建立全国性的缺血性卒中病种医疗质量持续评价和改进信息平台,实现与临床路径和操作规范等相结合的持续反馈和改进。医院接受医疗质量持续改进的干预措施有助于改善缺血性卒中患者短期和长期结局,进一步支持开展医疗质量持续改进。
建立质量控制、效果评价体系更有助于改善脑卒中医疗质量,在这个体系中完成医疗质量评估,并针对性地采取改善医疗质量的行动。另外,目前很多医生过分热衷于新技术,这项研究提示,脑卒中临床诊疗中更应该倾向有证可依的成熟技术,提升转化医学研究T3转化的研究水平和临床实践,落实临床指南是保障患者安全和医疗质量的重中之重。
 
Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China
Golden-bridge was a multicenter, cluster-randomized clinical trial, aiming to determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures, short-term and long-term outcomes in patients with acute ischemic stroke (AIS) in China. The study was published in the JAMA on June 29, 2018. It is a top cluster-randomized clinical trial of stroke care quality and enhances the role of stroke care quality improvement in the stroke management.
The findings showed that a multifaceted quality improvement intervention compared with usual care resulted in a statistically significant but small improvement in hospital personnel adherence to evidence-based performance measures in patients with acute ischemic stroke when assessed as a composite measure, but not as an all-or-none measure. Hospitals receiving the multi-interventional tools of stroke care have better short-term and long-term patients’ outcomes. This study supports to establish a nationwide information platform of stroke care quality assessment and improvement and implement clinical pathways and standard operation protocols of stroke care.