Quality Improvement in Stroke Prevention (QUISP)

Phase 4

Completed

• Conditions: Ischemic Stroke

• Registration Number: NCT00328640
• Lead Sponsor: University of California, San Francisco

Brief Summary

Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke:

1. Treatment with statins,

2. Control of hypertension, and

3. Anticoagulation in patients with atrial fibrillation.

Detailed Description

There are several proven strategies for prevention of recurrent ischemic stroke, including use of statins, treatment of hypertension, and anticoagulation in patients with atrial fibrillation. Preliminary analyses suggest that only 9-15% of Kaiser Permanente Northern California's ischemic stroke patients receive optimal care for secondary prevention of stroke. The purpose of this study is to determine whether or not a quality improvement (QI) intervention can improve the care received by stroke patients. This project consists of a randomized trial of standardized stroke discharge order forms to improve adherence with best practices in secondary stroke prevention. The primary research question is: Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke: (1) treatment with statins, (2) control of hypertension, and (3) anticoagulation in patients with atrial fibrillation.

The primary outcome will be the proportion of patients receiving optimal treatment, as defined by these three goals. The impact of the intervention will be measures as a change after-to-before at intervention hospitals compared to non-intervention (control) hospitals, with the institution as the unit of analysis. Secondary analyses will evaluate the impact of the intervention on each of these components and on 6-month and 1-year rates of mortality, readmission for stroke, and costs of care after discharge.

Study Timeline

• Study Start: 2005-12
• Study First Submitted: 2006-05-18
• Study First Submitted QC: 2006-05-18
• Study First Posted: 2006-05-22
• Study Completion: 2007-03
• Status Verified: 2007-04
• Last Update Submitted: 2007-04-25
• Last Update Posted: 2007-04-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1500

Inclusion Criteria

Ischemic stroke Kaiser-Permanente Health Plan Member with Pharmacy Benefit Discharged alive to home

Exclusion Criteria

tpA patients Hemorrhagic stroke TIA Significant comorbidities

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Medication utilization
Best Practices
Recurrent stroke

Secondary Outcome Measures

Name	Time	Method
Mortality
Morbidity
Cost
Hospital readmission

Trial Locations

Locations (1)

Kaiser-Permanente Division of Research; 🇺🇸 Oakland, California, United States