Background: Previous studies have demonstrated that guideline-based interventions on acute ischemic stroke were more applied in clinical practice. But it is unclear whether there were care or outcome discrepancies between teaching and non-teaching hospitals in China.
Methods: In China National Stroke Registry II, the data of 19,604 acute ischemic stroke patients within 7 days after symptom onset was obtained from June 2012 to January 2013. Acute ischemic stroke care quality indicators according to national guideline in clinical practice were defined as: (1) composite score for evaluating neurological deficits, (2)intravenous recombinant tissue plasminogen activator in patients who arrived within 2 hours after symptom onset and treated within 3 hours, (3) antithrombotic therapy within 48 hours and at discharge, (4) dysphagia screening, (5) deep vein thrombosis prophylaxis within 48 hours, (6) catorid imaging, (7) anticoagulation therapy at discharge for patients with atrial fibrillation/flutter, (8) LDL≥100 mg/dL or LDL not documented, (9) antihypertension therapy at discharge for patients with hypertension, (10) hypoglycemic therapy at discharge for patients with diabetes, (11)smoking cessation, (12)storke education, (13)rehabilitation. The outcomes were all-cause death, stroke recurrence events, and disability at 3, 6 and 12 month after discharge. Disability was evaluated by modified Rankin Score(≥3). The baseline characteristics were balanced by propensity score matching. Cox model with shared frailty model and logistic regression with generalized estimating equation were used to analysis the association between teaching and non-teaching hospitals on death, stroke recurrence events and disability.
Results: Among 19604 patients across 217 hospitals, there were 11313 patients from 125(57.6%) teaching hospitals and 8291 patients from 92(42.4%) non-teaching hospitals before matching. A total of 15974 patients drawn from teaching and non-teaching hospitals were matched to analyze. Compared with patients in teaching hospitals, less patients with atrial fibrillation/flutter in non-teaching hospitals were prescribed anticoagulation (15.8% versus 26%, P<0.01 ) and non-teaching hospital patients with diabetes had lower hypoglycemic therapy at discharge (69.8% versus 77.5%, P<0.01). Outcome result showed that patients in teaching hospitals had lower risk of disability at 3 month comparing to whom in non-teaching hospitals(adjusted hazard ratio 0.88, confidence interval 0.78-0.99, P=0.0398).
Conclusions: Teaching hospitals intervened in the patients with atrial fibrillation/flutter and diabetes more actively than non-teaching hospitals. And patients in teaching hospitals had better clinical outcome on disability at 3 month. Further studies should be explored to improve the ischemic stroke care and outcome in non-teaching hospitals.