Stroke: Multicenter, Forward-Looking, Control, Pre- and Post-Mass Improvement Study of Acute Stroke Care (Stroke123)

Hospital acceptance of evidence-based stroke care variesThe purpose of this paper is to determine the impact of multi-project plans involving economic incentives and quality improvement interventions on stroke care processesa forward-looking study of clinical quality index improvement interventions in 19 hospitals in Queensland, Australia, between 2010 and 2015, compared historical comparisons with 23 other Australian hospitalsAfter regular baseline review and feedback (control phase, 30 months), interventions involving economic incentives were implemented (21 months), followed by an externally driven quality improvement workshop and the development of an action plan (9 months)The post-intervention phase is 13 monthsThe analysis came from previous ongoing audits in Queensland and subsequent lying at the Australian Stroke Clinical RegistryMain outcome: the change of the compliance median overall score of 8 indicatorsSecondary outcome: A change in compliance with the optional indicators and four national indicators covered in the action plan compared to other hospitals in AustraliaMultivariate analysis to adjust the clustered dataa total of 17,502 patients (median age 74 years; 46 per cent female) and 20,484 patients from other Australian hospitalsPatient characteristics were similar between groupsThroughout the study period, the main outcomes improved by 18% (95% CI, 12-24%)The biggest improvement was with the introduction of economic incentives (14 per cent; 95 per cent CI, 8-20 per cent), while the indicators covered in the action plan provided an 8 per cent improvement (95 per cent CI, 1%-17 per cent)The national score (4 indicators) improved by 17% (95 per cent CI, 13 per cent to 20 per cent), while the other Australian hospitals changed by 0 per cent (95 per cent CI, -0.03 to 0.03)In Queensland, the rate of stroke unit visits is much better than in other Australian hospitals (P 0.001)the results, which are described above, show that quality improvement interventions have significantly improved clinical practice These results are driven primarily by economic incentives, but are also driven by externally driven workshops on quality improvement Assessments need to be made in other regions