Implementation of Regional Acute Stroke Care Map Is Associated With Improved Stroke Care Quality In Chiness Urban Area
C. Dong1, Y. Sui1, L. Zheng2, Y. Xian3, H. Zheng4, B. Xu1, L. Ren1, Y. Xiao1, H. Zhu1.
1Shenyang First People’s Hospital, Neurology, Shenyang, China.
2Shengjing Hospital of China Medical University, Clinical Epidemiology, Shenyang, China.
3Duke University Medical Center, Neurology, Durham, USA.
4Beijing Tiantan Hospital of Capital Medical University, Neurology, Beijing, China.
Abstract Text
Background: Although thrombolytic therapy is an effective treatment for acute ischemic stroke (AIS), the rate of thrombolysis remains as low as 2.4% in China. We investigated if the implementation of national construction of Acute Stroke Care Map (ASCaM) in China is associated with an improvement of acute stroke care quality in Shenyang metropolitan area.
Methods: The ASCaM comprises of 9 strategies of improving stroke care quality (Table), and has been implemented through a network consisted of 20 tertiary hospitals (Figure). Onset-to-Door Time (ODT), Door-to-Needle Time (DNT), tPA% within 4.5h and tPA% among all ischemic stroke patients were compared before (8th April 2017 to 15th July 2017) and after (16th July 2017 to 13th October 2017) the implementation of ASCaM.
Results: Compared with "pre-ASCaM era", "ASCaM era" was associated with a significantly reduction in ODT (113.19±54.78 vs. 133.66±58.47 minutes, P<0.001), increased rate of tPA application within 4.5h (70.1% vs. 59.0%; OR, 1.235; 95%CI, 1.08-1.41; P<0.05) and increased tPA% among all ischemic stroke patients (8.0% vs 5.8%; OR, 1.16; 95%CI, 1.08-1.24; P<0.001). However, DNT (57.36±25.92 vs. 57.45±30.94 minutes, P=0.97) remained unchanged before and after the ASCaM.
Conclusions: The implementation of ASCaM was associated with increased rate of tPA application and shorter ODT. The ASCaM integrated and synergized resources for intravenous thrombolysis. Future study will evaluate the association between ASCaMs with outcomes.

IMPLEMENTATION OF REGIONAL ACUTE STROKE CARE MAP IS ASSOCIATED WITH IMPROVED STROKE CARE QUALITY IN CHINESE URBAN AREA