| Background Stroke has the characteristic of high incidence,high disability and high mortality,and has become the first killer to the health of our residents.Among them,more than 70% was ischemic stroke.Studies showed that the quality of medical care was one of the key factors that affected the prognosis of ischemic stroke patients.European and American experience showed that improving the quality of medical care can effectively improved the prognosis and the quality of life of ischemic stroke patients.China's national stroke registration study also showed that the quality of medical care for ischemic stroke in China was continuous improved and improving the prognosis of patients.purpose Evaluation of the key performance indicators of the quality of medical care for ischemic stroke in Fujian Province.Analysis of the factors that influence the quality of medical care.And provide reference for continuous improve the quality of medical care.Methods This study included 49 secondary hospitals and tertiary hospitals from Fujian Province.Each hospital was randomly selected 10 medical records whose discharged time were from January 1,2016 to October 31,2016.All patients' onset time were within 14 days.Diagnosed as cerebral infarction or transient ischemic attack.The International Classification of Diseases code(ICD-10)was I63 or G45.900,respectively.Data were collected from the patient's medical history home page,the medical history record,doctor's advice and neurological assessment table.According to the collected data,compared the differences of key performance indicators among tertiary hospital and secondary hospital,teaching hospital and nonteaching hospital,the second and third line city hospital and the four line and below city hospital.Multivariate logistic regression were used to analyze the factors that may affect the implementation of key performance indicators.Result In our study,a total of 464 medical records were included,436 were diagnosed as cerebral infarction and 28 were transient ischemic attack.The median age of the subjects were 69.0(61.0-77.0)years.Among them 275 were males.1.Compared the key performance indicators of quality of medical care for ischemic stroke among different hospitals in Fujian Province1.1 Compared with the tertiary hospital,the secondary hospital's antithrombotic within 48 hours of admission(87.2% vs.93.7%,P = 0.018),NIHSS score(37.9% vs.60.8%,P <0.001),dysphagia screening(26.0% vs.54.0%,P <0.001),DVT prophylaxis(20.3% vs.47.8%,P = 0.001)had lower implementation rates.1.2 Compared with the teaching hospital,the nonteaching hospital's antithrombotic within 48 hours of admission(86.5% vs.92.7,P=0.030),NIHSS score(20.2% vs.65.4%,P<0.001),dysphagia screening(16.6% vs.53.2%(19.1% vs.56.4%,P=0.001),DVT prophylaxis(19.6% vs 42.5%,P = 0.008),discharged antithrombotic(88.0% vs.96.4%,P = 0.001)and discharged statin therapy(88.7% vs.97.2%,P <0.001)had lower implementation rates.1.3 Compared with different types of medical insurance,there was no significant difference among the key performance indicators.2.Compared the Key Performance Indicators between Fujian Province and the Nationalwide2.1 Compared with the tertiary hospital in Fujian Province and the nationalwide,the implementation of NIHSS score(75.0% vs.60.6%),dysphagia screening(76.7% vs.54.0%),rehabilitation(72.9% vs.53.3%),DVT prophylaxis(48.5% vs.47.8%)in the Fujian province were lower than the national average.The other key performance indicators were higher.2.2 Compared with the secondary hospital in Fujian Province and the nationalwide,the implementation of NIHSS score(67.1% vs.37.9%),dysphagia screening(75.9% vs.26.0%),rehabilitation(68.8% vs.47.4%),DVT prophylaxis(44.6% vs.20.3%)in Fujian province was lower than the national average.The other key performance indicators were higher.3.Analysis of the influence factors of key performance indicators Multivariate logistic regression analysis showed that:(1)High-grade hospital(OR 1.854,95% CI1.201-2.863),implementation of thrombolytic(OR 5.263,95% CI2.923-9.478)and diagnosed as ischemic stroke(OR 6.908,95% CI2.427-19.662).The implementation of NIHSS score were better.(2)Diagnosed as ischemic stroke(OR 2.781,95%CI1.040-7.434),high-grade hospital(OR 2.734,95% CI1.755-4.258),implementation of thrombolytic(OR 3.147,95% CI1.720-5.756).The implementation of dysphagia screening were better.(3)Combined with atrial fibrillation(OR 0.174,95%CI 0.080-0.378)and implementation of thrombolytic(OR 2.302,95% CI 1.082-4.897).The implementation of antithrombotic within 48 hours of admission were better.(4)Longer length of stay(OR 1.061,95% CI 1.022-1.101)and teaching hospital(OR 1.933,95% CI 1.258-2.969).The implementation of rehabilitation were better.(5)High-grade hospital(OR 3.363,95% CI1.494-7.571),the implementation of DVT prophylaxis were better.(6)Combined with atrial fibrillation(OR 0.037,95% CI 0.008-0.171)and teaching hospital(OR 5.254,95% CI 1.865-14.085).The implementation of discharged antiplatelet were better.(7)Affect the implementation of other key performance indicators were associated with the patients' own factors.Conclusion The implementation of key performance indicators for the quality of medical care for ischemic stroke in Fujian province.The tertiary hospitals' were better than secondary hospitals',teaching hospitals' were better than non-teaching hospitals'.The implementation of key performance indicators such as NIHSS score,dysphagia screening,rehabilitation,DVT prophylaxis were lower than the national average in Fujian province.Care should be given to the relatively weak key performance indicators in the continuous improvement of the quality of medical care. |
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