Process Evaluation Study On Long Term Timely Intervention Program Of TCM Of Cerebral Infarction

Background:Stroke has bring about huge economic losses to the state and society, because of its high morbidity, recurrence rate, disability rate, mortality rate and rising control cost; it has become to an important public health problem effect on our contry. We have got lots of research achievement in comprehensive treatment program of TCM optimization and formation of Clinical Practice Guidelines on stoke, but not sufficient in transformation and application of the achievements. In recent years, Multiple clinical practice guidelines of stoke based on a large number of epidemiological surveys and clinical trials have been established, but still there is a huge gap between clinical practice and evidence-based guidelines. Process evaluation study on comprehensive treatment program of Stroke or guidelines is relatively lack, the application of the programsand guidelines is insufficiency. Accelerate transformation progress from scientific research to clinical application is the key point of study on revention and treatment in Stroke. This study of process evaluation on long term timely intervention program of TCM of cerebral infarction belongs to T3Translational research.Objective:Preliminary Establish Evaluation index of Long Term Timely Intervention program of TCM of Cerebral infarction, evaluate the execution situation of the program, in order to provide a reference for further optimization of the program.Method:1. Through literature research, we reviewed the research profile of comprehensive treatment program of TCM on stoke, at home and abroad to ask questions, and put forward some problems;Through the study on the literature of process evaluation and compliance, we Summarized methods and concepts about process evaluation study of comprehensive program of TCM.2. Draw on the results of modern medical research, and based on two stroke diagnosis and treatment guidelines, We preliminary established evaluation index of Long term timely intervention program of TCM of cerebral infarction.3. Using the11evaluation index, we evaluated the execution situation of the program, in order to provide a reference for further optimization of the program, then we evaluated the scientific and feasibility of the evaluation index, and analysis the obstacles in the of program implementation and impact of program compliance.Results:1. Based on guidelines, we extract the key elements of the program, and formatted11 evaluation index, containing performance index of treatment program and clinical evaluation: Syndrome judgment score, Dispensing granules selection score, Panax notoginseng saponins Injection execution score, Acupuncture treatment execution score, Massage therapy execution score, Rehabilitation execution score, Anti-platelet drugs execution score, Neuroprotective agents execution score, Rehabilitation evaluation execution score, NIHSS assessment execution score, Imaging inspection execution score.2. We evaluated the execution situation of the program on100cases, the results:Syndrome judgment score is4.47,the Scoring rate is89.4%; Dispensing granules selection score is7.90,the Scoring rate is79.0%; Panax notoginseng saponins Injection execution score was4.08, the Scoring rate was81.6%; Acupuncture treatment execution score was6.42, the Scoring rate was64.2%; Massage therapy execution score was5.02, the Scoring rate was50.2%; Rehabilitation execution score was7.20,the Scoring rate was72.0%; Anti-platelet drugs execution score was3.53,the Scoring rate was88.3%; Neuroprotective agents execution score, was1.20,the Scoring rate was60.0%; Rehabilitation evaluation execution score was1.67,the Scoring rate was83.5%; NIHSS assessment execution score was4.91,the Scoring rate was98.2%; Imaging inspection execution score was4.77,the Scoring rate was95.4%; total score mean was51.17, the score rate was75.3%. Indexs score of clinical evaluation was better than that’s of treatment program, especially in Rehabilitation evaluation and NIHSS assessment, the rates were both larger than95%. In the aspect of treatment plan, the execution of Dispensing granules selection score, Panax notoginseng saponins Injection execution score, and Anti-platelet drugs execution score was quite satisfactory, the execution of Acupuncture treatment execution score, Massage therapy execution score. Rehabilitation execution score, and Neuroprotective agents execution score was poor.3. We used3kinds of comprehensive evaluation method to compare the execution of the program in5clinical research centers. Composite index method:Sort by composite index I of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. TOPSIS method:Sort by Ci of5Clinical Research Centers, they were in order of Center C, Centre A, Centre B, center D and Center E. RSR method:Sort by RSR of5Clinical Research Centers, they were in order of Center C, Centre B, Centre A, center D and Center E. Distinguished the levels of5centers, center C was in the first level, center A and B was in the second level, center Dand E were in the third level.The results used in3different methods were basically the same, so we can use3kinds methods above synchronously to evaluate implementation process of diffrente clinical research centers.Conclusion:The index system can evaluate the implementation of the program and its changes, and analyze the existing obstacles in the implementation of the program and impact of program compliance.