Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：BMJ open

Publication type: Observational Study

IF(IF): 2.9

PMID: 38553086 Link To Pubmed Full text Download

Stroke has become an enormous health issue across the world. China bears the biggest stroke burden, with prevalence, incidence, and mortality rates were 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively. Stroke is also a major cause of short-term functional impairment and long-term disability in the absence of adequate treatment and rehabilitation, leaving more than half of stroke survivors aged ≥65 years with impaired mobility. Systematic reviews has carried out that rehabilitation is the most effective way to reduce the disability rate of stroke, and it is also an indispensable key point in the organizational management of stroke. Both international and Chinese clinical guidelines recommend that all individuals with acute ischemic stroke (AIS) should be assessed for rehabilitation in the acute care setting to determine rehabilitation needs, but in clinical practice rehabilitation needs are not always assessed and that people who need rehabilitation do not always receive it, which increase the risk of functional dependence and the subsequent burden on informal carers and social care services. Rehabilitation assessment during the acute hospitalization is a widely recognized indicator of stroke care quality. Findings from the study on the analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines indicate that almost 97.4% of the patients with ischemic stroke at participating institutions had an assessment for rehabilitation documented, but in china, only less than 60% of patients had an assessment for rehabilitation. To bridge these remarkable gaps between guideline recommendations and clinical practices, the Chinese Stroke Association (CSA) initiated the Chinese Stroke Center Alliance (CSCA) to establish the national hospital-based stroke care quality assessment and improvement platform. Four years passed, little is known about the current practice and what influencing factors changed in China on the rehabilitation for AIS patients during hospitalization. Compared with the results of previous studies, the reasons for the changes were analyzed to provide clues for improving the quality of stroke rehabilitation. Using the data from the CSCA, the primary objectives of this study were to determine the rate among participating hospitals and frequency and determinants of rehabilitation documented among AIS patients in current clinical practice.

The implementation and analysis of the study is based on CSCA. The CSCA is a national, hospital-based, multicentre, voluntary, multifaceted intervention and continuous QI initiative. Patients were recruited consecutively in all 1476 hospitals from August 2015 to July 2017, who met the following criteria: (1) are aged 18 years or older; (2) have a primary diagnosis of acute ischemic stroke confirmed by brain CT or MRI; (3) are within 7 days of symptom onset; (4) are admitted either directly to wards or through the emergency department. Patients with TIA were excluded. The proportion of patients who received assessment of rehabilitation was described at the patient level. The adherent rate of rehabilitation assessment at the hospital level was defined as the total number of eligible patients receiving rehabilitation assessment divided by the total number of eligible patients of each hospital. Baseline patient-level characteristics were compared for patients with and without a rehabilitation assessment and hospital-level features were compared for hospitals above and below the median rate of assessment by using Pearson chi-square tests for categorical variables and Mann-Whitney U test for continuous variables. A multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was performed to identify patient and hospital characteristics independently associated with rehabilitation assessment. All tests are two-tailed with p < 0.05 to be considered as the level of statistical significance. All analyses were performed by using SAS Version 9.3 software.