Analysis On Quality Control Of Acute Ischemic Stroke In Hainan Province

OBJECTIVE:To review the medical quality of acute ischemic stroke in Hainan province from 2018 to 2020,find and analyze the existing problems,and provide reference for the improvement of the medical quality of acute ischemic stroke in Hainan province.METHODS:Data of acute ischemic stroke patients reported by second and third level hospitals in Hainan province on the data platform of Chinese Stroke Center Alliance form January 1,2018 to November 30,2020 were collected for statistical analysis,including general situation,type of medical insurance,risk factors,and implementation of medical service process indexes during hospitalization.Horizontal comparison was made between the data of Hainan Province in 2018 and the national data;longitudinal comparison was made between the data of Hainan Province in 2018,2019 and 2020;and comparison was made between the data of secondary and tertiary hospitals in Hainan Province.RESULTS:A total of 1773 cases of acute ischemic stroke were collected in Hainan province in 2018.Compared with the national data,there are differences in gender composition,medical insurance type composition and risk factors/comorbidity ratio of patients in Hainan Province,and the differences are statistically significant.Comparing KPI indicators,the completion rate of most of Hainan’s key performance indicators in 2018 was significantly lower than that of the whole country.By comparing the KPI indexes of secondary and tertiary hospitals in 2018,the rate of rt-PA thrombolysis and the proportion of swallowing function screening in secondary hospitals were higher than those in tertiary hospitals,while the proportion of deep vein thrombosis prevention,the pr oportion of hypertension and anticoagulant treatment in patients with atrial fibrillation were lower than those in tertiary hospitals,with statistical significance.KPI nearly three years the target completion of Hainan province is on the rise,NIHSS score,antithrombotic,swallowing function hospital screening,early antithrombotic and merger of anticoagulant therapy in patients with atrial fibrillation are increased year by year,the proportion of basic meet or exceed the national average,but the proportions of the early thrombolysis and rehabilitation evaluation there is decline,and the difference was statistically significant.CONCLUSIONS:The gender composition,medical insurance type composition and the proportion of risk factors of acute ischemic stroke patients in Hainan province are significantly different from the national data.Compared with the Dational data,the completion rate of KPI indicators in Hainan Province in 2018 was generally low,vwhich mainly included swallowing function assessment and DVT prevention-The indexes of acute phase in secondary hospitals were better than those in tertiary hospitals,and the indexes of discharge in tertiary hospitals were better.In recent three years,the data KPI index shows an overall upward trend.In recent three years,the proportion of early thrombolysis and rehabilitation evaluation has decreased rather than increased,and more detailed data are needed to analyze the reasons.OBJECTIVE:To analyze patient-related factors that influence key performance indicators(KPIs)in acute ischemic stroke.METHODS:To collect a 3 armour hospital of hainan province in 2018 admitted patients with acute ischemic stroke data,including general data,cultural degree,to see a doctor,hospital time(working days),mergers,KPI completion risk factors,using multiariable Logistic regression analysis,found the related factors influencing the KPI execution.RESULTS:A total of 317 eligible patients were included in this study.Logistic analysis results showed that patients≤50 years old and≤4.5 hours from onset to treatment were more likely to obtain NIHSS scores after admission.Early intravenous thrombolysis was not readily available to patients admitted 3.5 hours after onset;Patients aged less than 70 years were more likely to receive early antithrombotic therapy;Patients aged 60 years or less and with no smoking history were more likely to obtain DVT prevention;Patients aged 50 years or less were less likely to be screened for swallowing function;Patients with age≤60 years old were more likely to receive rehabilitation function assessment/exercise,while those with education level below primary school were less likely to receive rehabilitation function assessment/exercise.Patients aged less than 70 years are more likely to receive anticoagulant therapy;All the above were statistically significant(P<0.05).The longer the time from onset to treatment,the easier it was to receive anticoagulant therapy upon discharge,but the difference was not significant(P<0.1).There was no statistical significance in the influence of all factors on antihypertensive and hypoglycemic treatment.CONCLUSION:Patients’ basic conditions affect the implementation of KPI indicators in the diagnosis and treatment process of acute ischemic stroke patients,and age is the main influencing factor.Younger patients are more likely to obtain NIHSS score,early antithrombotic therapy,DVT prevention,rehabilitation evaluation/exercise.and anticoagulant therapy for patients with atrial fibrillation.In addition,patients admitted within 3.5 hours of onset were more likely to receive early intravenous thrombolysis,and patients with higher educational attainment were more likely to receive rehabilitation evaluation or exercise during hospitalization.In order to improve the medical quality of acute ischemic stroke,physicians should pay attention to these factors affecting the medical quality.