作为质量改进协作一部分的具体干预措施可改善缺血性卒中患者的照护

文献信息

中文摘要

引言： 尽管有证据表明管理发热、血糖（糖）以及进行吞咽筛查（FeSS）可降低死亡率和残疾，但卒中照护的指南依从性仍存在差异。我们建立了一个质量改进协作，以改善缺血性卒中的照护流程，重点关注这三项建议。随后我们增加了两项额外的照护流程活动：日常生活活动能力（ADL）筛查和抑郁筛查，统称为FeSS+。
方法： 在这项多中心干预研究（n = 24）中，我们回顾性分析了每家中心2019年干预前（测量期1 [MP1]）和2022年干预后（测量期2 [MP2]）连续30份缺血性卒中患者记录。所有医院均收到其MP1表现的反馈，并获得可选的FeSS+电子学习工具。我们比较了MP1与MP2之间的依从性，并评估了电子学习工具的影响。
结果： MP1期间收集了580例患者的数据，MP2期间收集了588例患者的数据。电子学习工具已提供给18家医院（75%）的团队。体温测量（18%至25%，p = 0.004）和吞咽筛查（36%至59%，p < 0.001）的依从性有所改善。血糖、ADL或抑郁筛查未见显著变化。仅在推广了电子学习工具的医院中观察到血糖管理、吞咽筛查和抑郁筛查依从性的改善（分别为p = 0.01、<0.001、<0.001）。未使用电子学习的医院体温测量改善更明显（OR 2.62 vs. 1.27；p = 0.03）。
讨论： 在收到反馈后，我们观察到体温测量和吞咽筛查有所改善。电子学习工具的推广与血糖测量、吞咽筛查和抑郁筛查依从性增加相关，凸显了具体干预措施的作用。然而，总体依从性仍然较低，强调需要持续进行质量改进。

英文摘要

INTRODUCTION: Adherence to guidelines for stroke care varies, despite evidence that managing fever, glycemia (sugar), and conducting swallowing screening (FeSS) reduces mortality and disability. We established a quality improvement collaborative to improve care processes for ischemic stroke, with a focus on these three recommendations. We then added two additional care process activities: screening for activities of daily living (ADL) and depression, collectively defined as FeSS+.
METHODS: In this multicenter intervention study (n = 24), we retrospectively analyzed 30 consecutive patient records per center of ischemic stroke patients in 2019, pre-intervention (measurement period 1 [MP1]), and in 2022, post-intervention (measurement period 2 [MP2]). All hospitals received feedback on their MP1 performance, and an optional e-learning tool on FeSS+ was also offered. We compared adherence between MP1 and MP2 and assessed the impact of the e-learning tool.
RESULTS: Data were collected from 580 patients during MP1 and 588 patients during MP2. E-learning tools were delivered to teams at 18 hospitals (75%). Adherence improved for temperature measurement (18 to 25%, p = 0.004) and swallowing screening (36 to 59%, p < 0.001). No significant changes were observed for glycemia, ADL, or depression screening. Improvements in adherence to glycemia management, swallowing screening, and depression screening were observed only among hospitals that disseminated the e-learning tool (p = 0.01, <0.001, <0.001, respectively). Temperature measurement improved more in hospitals without e-learning (OR 2.62 vs. 1.27; p = 0.03).
DISCUSSION: We observed improvements in measuring temperature and swallowing screening after receiving feedback. The dissemination of the e-learning tool was associated with increased adherence to glycemic measurement, swallowing screening, and depression screening, underscoring the role of specific interventions. However, overall adherence remained low, highlighting the need for continued quality improvement.