2022
Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China
Li Z, Wang C, Zhang X, Zong L, Zhou H, Gu H, Jiang Y, Pan Y, Meng X, Zhou Q, Zhao H, Yang X, Wang M, Xiong Y, Zhao X, Wang Y, Liu L, Ma X, Morgan L, Xian Y, Schwamm L, Wang Y. Rationale and design of a stepped wedge cluster randomised trial to improve acute reperfusion treatment quality for stroke: IMPROVE stroke care in China. Stroke And Vascular Neurology 2022, 7: 451-456. PMID: 35354662, PMCID: PMC9614172, DOI: 10.1136/svn-2021-001461.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIntravenous thrombolysisReperfusion therapyEndovascular thrombectomyEligible patientsPrimary outcomeWedge clusterQuality improvement interventionsMixed-effects logistic regressionTreatment qualityIntraclass correlation coefficientReperfusion treatmentHospital delayIschemic strokeStroke centersTreat principleStroke careEfficacy analysisChina trialEffective treatmentNumber of casesImprovement interventionsPatientsComprehensive interventionLogistic regression
2021
Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China
Gu H, Yang X, Wang C, Zhao X, Wang Y, Liu L, Meng X, Jiang Y, Li H, Liu C, Wangqin R, Fonarow G, Schwamm L, Xian Y, Li Z, Wang Y. Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China. JAMA Network Open 2021, 4: e2120745. PMID: 34387677, PMCID: PMC8363916, DOI: 10.1001/jamanetworkopen.2021.20745.Peer-Reviewed Original ResearchConceptsTransient ischemic attackChinese Stroke Center AllianceMajor adverse cardiovascular eventsHospital clinical outcomesQuality improvement studyIschemic strokeIntracerebral hemorrhageIschemic attackClinical characteristicsClinical outcomesPoor outcomeIntravenous recombinant tissue plasminogen activatorTemporal improvementRecombinant tissue plasminogen activatorAdverse cardiovascular eventsIn-Hospital OutcomesUse of anticoagulantsComposite scoreImprovement studyTissue plasminogen activatorMean composite scoreHealth care systemHospital complicationsTIA admissionsTIA care
2018
Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, Peterson E, Schwamm L, Fonarow G, Smith S, Bettger J, Wang D, Li H, Xian Y, Wang Y. Evidence-Based Performance Measures and Outcomes in Patients With Acute Ischemic Stroke. Circulation Cardiovascular Quality And Outcomes 2018, 11: e001968. PMID: 30557048, DOI: 10.1161/circoutcomes.115.001968.Peer-Reviewed Original ResearchMeSH KeywordsAgedBrain IschemiaChinaClinical CompetenceDisability EvaluationEvidence-Based MedicineFemaleFibrinolytic AgentsGuideline AdherenceHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePractice Guidelines as TopicPractice Patterns, Physicians'Prospective StudiesQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk FactorsSmoking CessationStrokeStroke RehabilitationThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeConceptsAcute ischemic strokeIschemic strokeOptimal complianceStroke careChina National Stroke RegistryEvidence-based performance measuresMultivariable Cox modelNational Stroke RegistryFavorable functional outcomeProspective cohort studyEvidence-based guidelinesRoutine clinical practiceCause of deathIntravenous tPAStroke recurrenceStroke RegistryCohort studyNationwide registryClinical outcomesFunctional outcomeCare measuresImproved outcomesHospital measuresCox modelClinical practiceInternational Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program
Wangqin R, Laskowitz D, Wang Y, Li Z, Wang Y, Liu L, Liang L, Matsouaka R, Saver J, Fonarow G, Bhatt D, Smith E, Schwamm L, Bettger J, Hernandez A, Peterson E, Xian Y. International Comparison of Patient Characteristics and Quality of Care for Ischemic Stroke: Analysis of the China National Stroke Registry and the American Heart Association Get With The Guidelines––Stroke Program. Journal Of The American Heart Association 2018, 7: e010623. PMID: 30371291, PMCID: PMC6474951, DOI: 10.1161/jaha.118.010623.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryNational Stroke RegistryAcute ischemic strokeStroke RegistryIschemic strokeChinese patientsDeep venous thrombosis prophylaxisHealth Stroke ScaleVenous thrombosis prophylaxisAcute stroke careAdministration of thrombolyticsEvidence-based guidelinesAmerican Heart AssociationQuality of careBackground AdherenceDischarge antithromboticsThrombosis prophylaxisCessation counselingStroke ProgramStroke ScaleClinical characteristicsHospital arrivalNeedle timePatient characteristicsSecondary preventionQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospitalEffect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial
Wang Y, Li Z, Zhao X, Wang C, Wang X, Wang D, Liang L, Liu L, Wang C, Li H, Shen H, Bettger J, Pan Y, Jiang Y, Yang X, Zhang C, Han X, Meng X, Yang X, Kang H, Yuan W, Fonarow G, Peterson E, Schwamm L, Xian Y, Wang Y. Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial. JAMA 2018, 320: 245-254. PMID: 29959443, DOI: 10.1001/jama.2018.8802.Peer-Reviewed Original ResearchConceptsMultifaceted quality improvement interventionAcute ischemic strokeQuality improvement interventionsEvidence-based performance measuresIschemic strokeImprovement interventionsControl groupUsual careClinical trialsIntervention groupEvidence-based stroke careCluster-randomized clinical trialClinical vascular eventsCo-primary outcomesLong-term outcomesHospital mortalityStroke RegistryVascular eventsSecondary outcomesPrimary outcomeStroke careCare protocolsClinical pathwayMAIN OUTCOMEPatients
2016
Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China
Li Z, Wang C, Zhao X, Liu L, Wang C, Li H, Shen H, Liang L, Bettger J, Yang Q, Wang D, Wang A, Pan Y, Jiang Y, Yang X, Zhang C, Fonarow G, Schwamm L, Hu B, Peterson E, Xian Y, Wang Y, Wang Y. Substantial Progress Yet Significant Opportunity for Improvement in Stroke Care in China. Stroke 2016, 47: 2843-2849. PMID: 27758941, DOI: 10.1161/strokeaha.116.014143.Peer-Reviewed Original ResearchConceptsChina National Stroke RegistryIntravenous thrombolytic therapyNational Stroke RegistryQuality Improvement ProgramHigher composite scoresStroke RegistryDysphagia screeningStroke careThrombolytic therapyAtrial fibrillationSmoking cessationLeading causeStroke educationMultivariate analysisStudy periodAdherenceComposite scoreHospitalPhase 2Phase 1CareRegression modelsOddsOverall qualitySignificant improvement
2015
Rationale and design of a cluster-randomized multifaceted intervention trial to improve stroke care quality in China: The GOLDEN BRIDGE–Acute Ischemic Stroke
Wang Y, Li Z, Xian Y, Zhao X, Li H, Shen H, Wang C, Liu L, Wang C, Pan Y, Wang D, Bettger J, Fonarow G, Schwamm L, Smith S, Peterson E, Wang Y, investigators G. Rationale and design of a cluster-randomized multifaceted intervention trial to improve stroke care quality in China: The GOLDEN BRIDGE–Acute Ischemic Stroke. American Heart Journal 2015, 169: 767-774.e2. PMID: 26027613, DOI: 10.1016/j.ahj.2015.03.008.Peer-Reviewed Original ResearchConceptsMultifaceted quality improvement interventionAcute ischemic strokeQuality improvement interventionsIschemic strokeImprovement interventionsEvidence-based clinical pathwayEvidence-based performance measuresEvidence-based gapNew vascular eventsSecondary patient outcomesStroke care qualityGuideline-based recommendationsInitial symptom onsetCluster-randomized trialVascular eventsInhospital deathSymptom onsetPrimary outcomeCare protocolsAIS patientsIntervention trialsPatient outcomesClinical pathwayMultifaceted interventionsRoutine standard