Stroke Prevention and Treatment System in Shanghai: a Network of Public Healthcare of Stroke
- Conditions
- Stroke
- Interventions
- Other: stroke network and policy intervention
- Registration Number
- NCT02735226
- Lead Sponsor
- Shanghai Stroke Service System
- Brief Summary
The Shanghai Stroke Service System（4S） has been established as the network of stroke care in greater Shanghai metropolitan area. The system includes 11 territorial-care hospitals and their comprehensive stroke unites that provide 24h/7day acute stroke care to a population of 40 million in Shanghai. The System comprised of two consecutive phases, the acute phase that emphasized on providing thrombolysis, and the in-hospital phase that concentrated on the effort of recovery and secondary stroke prevention. The novel electronic data aquisition system provides the contiguous data of clinical care of stroke patients from the acute phase of management to inpatient rehabilitation. This system has been implemented and maintained as an ongoing quality of stroke care project that monitored the process of routine stroke care in Shanghai. It is funded by the Shanghai Municipal Commission of Health and Family Planning. Our analysis of the project was approved by the Ethics Committee, which agreed that no written informed consents were needed since the study only was consisted of a population-based retrospective data analysis.
- Detailed Description
The goal of Shanghai stroke service system is to promote and facilitate high quality standardized stroke care in Shanghai area. The 11 hospitals involved are committed to provide the best stroke care to their patients. This quality goal consists of two parts: the acute phase of stroke care and the subsequent care during the hospitalization. To accomplish this goal, each hospital has organized a multidisciplinary stroke team that will address day-to-day stroke care. Each hospital provides prioritized neuroimaging service to patients with acute stroke 24hr per day, 7days per week. A stroke neurologist is on site 24hr per day, 7 days per week in each hospital. This team will follow the guidelines to carry out standardized secondary stroke prevention once the patient has been admitted.
The stroke clinical pathway is available on line in computers of each hospital. This pathway can be accessed from hospital computers, or from outside.
Stroke team members in each hospital obtained and entered all data on each stroke patient: demographics, stroke onset time, onset to thrombolytic time, presenting NIHSS, timing of diagnostic procedures, treatment strategies, performance of quality measures, comorbidities, in-hospital mortality, etc. These data are contained in a three-page form, which are embedded in the electronic health record of each patient.
If ICD-10 stroke codes were entered as the primary discharge diagnoses, the electronic health record systems would not allow the discharge of the patient until all required documentation has been completed. The EHR would not allow for any empty fields before it could be closed. Data quality was assured by automatic feasibility checks. The novel electronic data acquisition system provides the continuous clinical care data on all stroke patients from their acute management phase to inpatient rehabilitation or discharge.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 100000
- 18 years old or older
- primary diagnosis as acute stroke or TIA within 7 days from onset
- admitted in stroke unit.
- child or teenager younger than 18 years old
- woman with pregnant
- outpatient
- any other reason that patient cannot be admitted for secondary prevention
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Acute Stroke patient stroke network and policy intervention Patients who are presented to hospital within 7days from onset. The key measurement of clinical quality controlled in patients with acute stroke managment and inhouse stroke care were record automatically
- Primary Outcome Measures
Name Time Method The acute stroke service and treatment provided in Shanghai area 5 years The phase of acute stroke therapy. Under this category, the acute stroke care specific quality measurement items are:
Stroke onset to hospital ER Time
Door to CT Time
Door to seen by a doctor Time
Door to IV TPA Time
Door to groin puncture time for IA therapy
Door to admission to a hospital bed TimeThe secondary prevention of stroke provided after discharge in Shanghai area 5 years 2. Secondary stroke prevention prescribed.
Antithrombotics prescribed
Swallowing evaluation performed before oral feeding starts
DVT prophylaxis prescribed
Anticoagulation for atrial fibrillation prescribed
Brain imaging including vascular imaging performed
Stroke education provided
Educating patient to stop smoking
Statins prescribed
Rate of catheter related UTI
Rate of aspiration pneumonia
Hospital length of stay
Discharge destination
The time frame for this project is 5 years. All elements of acute stroke care will be collected during the hospital stay.
- Secondary Outcome Measures
Name Time Method To assess the rate of antiplatelet agent used for stroke prevention. 5 years This would include the rate of patients being prescribed dual antiplatelet therapy, and the duration/compliance of taking antiplatelet medicine.
To assess the rate of using anticoagulant medication for stroke prevention in patients with atrial fibrillation. 5 years To assess the rate of bridging therapy used during hospitalization. Bridging therapy is to give intravenous or subcutaneous anticoagulation while waiting for warfarin to be therapeutic. In addition, the rate of prescribing new oral anticoagulants for stroke prevention in atrial fibrillation will be assessed,
Trial Locations
- Locations (11)
Zhongshan Hospital affiliated to Fudan University
🇨🇳Shanghai, Shanghai, China
Huashan Hospital，Fudan University
🇨🇳Shanghai, Shanghai, China
Shuguang Hospital affiliated to Shanghai Traditional Chinese Medicine University
🇨🇳Shanghai, Shanghai, China
The Shanghai Tenth People's Hospital, Tongji University
🇨🇳Shanghai, Shanghai, China
Renji hospital，Shanghai Jiaotong University School of Medicine
🇨🇳Shanghai, Shanghai, China
Shanghai Changhai Hospital
🇨🇳Shanghai, Shanghai, China
Shanghai Changzheng Hospital
🇨🇳Shanghai, Shanghai, China
Shanghai Jiao Tong University School of Medicine Ruijin Hospital
🇨🇳Shanghai, Shanghai, China
Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine
🇨🇳Shanghai, Shanghai, China
The Sixth People's Hospital affiliated to Shanghai Jiaotong University
🇨🇳Shanghai, Shanghai, China
Dongfang Hospital affiliated to Shanghai University of TCM
🇨🇳Shanghai, Shanghai, China