Year: 2010
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: OBJECTIVE: We evaluated the effect of performance feedback on acute ischemic stroke care quality in Minnesota hospitals. METHODS: A cluster-randomized controlled trial design with hospital as the unit of randomization was used. Care quality was defined as adherence to 10 performance measures grouped into acute, in-hospital, and discharge care. Following preintervention data collection, all hospitals received a report on baseline care quality. Additionally, in experimental hospitals, clinical opinion leaders delivered customized feedback to care providers and study personnel worked with hospital administrators to implement changes targeting identified barriers to stroke care. Multilevel models examined experimental vs control, preintervention and postintervention performance changes and secular trends in performance. RESULTS: Nineteen hospitals were randomized with a total of 1,211 acute ischemic stroke cases preintervention and 1,094 cases postintervention. Secular trends were significant with improvement in both experimental and control hospitals for acute (odds ratio = 2.7, p = 0.007) and in-hospital (odds ratio = 1.5, p < 0.0001) care but not discharge care. There was no significant intervention effect for acute, in-hospital, or discharge care. CONCLUSION: There was no definite intervention effect: both experimental and control hospitals showed significant secular trends with performance improvement. Our results illustrate the potential fallacy of using historical controls for evaluating quality improvement interventions. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that informing hospital leaders of compliance with ischemic stroke quality indicators followed by a structured quality improvement intervention did not significantly improve compliance more than informing hospital leaders of compliance with stroke quality indicators without a quality improvement intervention.
Source: Neurology
Authors: K. Lakshminarayan, C. Borbas, B. McLaughlin, N.E. Morris, G. Vazquez, R.V. Luepker, D.C. Anderson
Institution: University of Minnesota
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Heart Association, American Academy of Neurology, Northwestern University, Harvard University, University of Minnesota, Hennepin County Medical Center, Minneapolis Medical Research Foundation, Lunds Universitet, Hyderabad Eye Research Foundation, National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, National Heart, Lung, and Blood Institute, National Institute of Neurological Disorders and Stroke, National Center for Research Resources
OpenAlex ID: W2002421485