INTRODUCTION. In Québec (Canada), an action plan to reorganize stroke care, to introduce thrombectomy and to promote best practices with a tool kit was initiated following a province-wide field evaluation in 2013-2014. We compare quality of care in comprehensive stroke centers before and after implementation of this initiative.
METHODS. An evaluation of ischemic stroke treatment was conducted during two periods. Information from medical charts was entered into a centralized, secure website (REDCap). Results were compared for patients directly admitted to one of the four comprehensive stroke centers and treated with thrombolysis or thrombectomy from October 2016 to March 2017, versus those directly admitted to the same centers during the equivalent period in 2013-2014.
RESULTS. Patient median age (75 versus 76 years) and sex distribution (47% versus 46% female) were unchanged. Median door-to-scan time improved from 32 (25th to 75th percentile: 15-73) to 17(11-25) minutes. Number of patients treated with thrombolysis increased from 70 to 152. In 2016-2017, 57 patients had thrombectomy after thrombolysis; 24 had thrombectomy alone. For thrombolysis, median scan-to-needle time decreased from 41(22-60) to 21(12-37) minutes, while door-to-needle time decreased from 62(49-88) to 41(32-55) minutes. Proportion treated with thrombolysis ≤60 minutes increased from 47% to 80%. Proportion with standardized screening for dysphagia increased from 32% to 73%. In 2016-2017, 91% of patients were admitted to a stroke unit compared with 75%, previously.
CONCLUSIONS. Quebec’s provincial action plan and reorganization of care was associated with more ischemic stroke patients being optimally treated in comprehensive stroke centers.

QUALITY OF CARE FOR ISCHEMIC STROKE IN QUEBEC’S COMPREHENSIVE STROKE CENTERS BEFORE AND AFTER INITIATION OF A PROVINCIAL ACTION PLAN