Quality Improvement in Stroke Prevention (QUISP)

Completed

Phase 4 Results N/A

Trial Description

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.

Conditions

Interventions

Trial Design

  • Allocation: Randomized
  • Masking: Single Blind
  • Purpose: Prevention
  • Endpoint: Safety Study
  • Intervention: Single Group Assignment

Patient Involvement

Patients will be followed for improved adherence with best practices in secondary stroke prevention from hospitals using standardized discharge orders and hospitals who do not. Secondary analyses will evaluate the impact of the intervention [(1) treatment with statins, (2) control of hypertension, and (3) anticoagulation in patients with atrial fibrillation] on each of these components and on 6-month and 1-year rates of mortality, readmission for stroke, and costs of care after discharge.

Outcomes

Type Measure Time Frame Safety Issue
Primary Medication utilization, best practices, & recurrent stroke.
Secondary Mortality, morbidity, cost, & hospital readmission.
Primary Medication utilization
Primary Best Practices
Primary Recurrent stroke
Secondary Mortality
Secondary Morbidity
Secondary Cost
Secondary Hospital readmission

Sponsors