Background: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended stroke performance metrics was suboptimal in the past decade. We sought to determine whether adherence changed after the implementation of the China National Quality Management Initiatives.
Methods and Results: Data were obtained from the China National Stroke Registries (CNSR), and included 132 hospitals (12 173 patients) participated in CNSR Phase I (2007-2008) vs. 219 hospitals (19 604 patients) in CNSR Phase II (2012-2013). The overall adherence increased over time, as reflected by the higher composite score of 0.76 in 2012-2013 as compared with 0.63 in 2007-2008, and the increase in 9 of 13 individual metrics, including dysphagia screening, carotid imaging, rehabilitation evaluation, antithrombotics, lipid-lowering, antihypertensive medications, antidiabetic medications at discharge, smoking cessation, and stroke education). However, there were no significant improvements in the intravenous thrombolytic therapy, early antithrombotics, deep vein thrombosis prophylaxis, and anticoagulation for atrial fibrillation. Multivariate analysis suggested that there was a 1.17-fold increase in the odds of fulfilling care opportunities.
Conclusions: Adherence to stroke performance metrics increased recently, but significant opportunities remain for further improvement. Continuous stroke quality improvement program should be developed as a national priority in China.