Abstract 371: Stroke Healthcare Quality and Outcomes in Different Level of Stroke Centers

Background: Evidences support the stroke centers, including primary stroke center (PSC) and comprehensive stroke center (CSC) to improve stroke patient healthcare and outcomes.

Objects: We aimed to compare stroke healthcare quality and in-hospital outcomes between CSCs and PSCs in China.

Methods: Data were collected from acute stroke patients who were admitted to CSCs or PSCs that participated in the China Stroke Center Alliance (CSCA) program. Stroke care quality performances include: intravenous rtPA or endovascular thrombolysis (EVT) therapy in acute ischemic stroke (IS) patients, neurosurgical procedures of intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) patients, secondary prevention measures (such as medicines, dysphagia screening, rehabilitation assessment) in stroke patients. Performances of above were assessed by all-or-none measure and composite measure. The former was defined as the proportion of patients who received all the performance measures for which the patient was eligible. The latter was defined as the total number of eligible performance measures performed divided by the total number of performance measures for which a given patient was eligible. The composite measure was calculated for each patient and then averaged. Outcome was mainly estimated by in-hospital mortality. Multivariable logistic regression models were used to analyze the performances of stroke care quality and in-hospital outcomes between CSC and PSC.

Results: From 1st Aug, 2015 to 31st July, 2019, 750594 stroke patients from 1474 stroke centers (252 CSCs and 1222 PSCs) were analyzed. The mean age of patients was 65.8 (SD 12.2) years old, and 62.5% (469308) were male. By multivariable logistic regression analysis, patient characteristics (age, gender, NIHSS or GCS score, smoking and all the medical histories) and hospital characteristics (hospital level and location) were adjusted, patients in CSCs had higher all-or-none measure (adjusted OR, 1.22 [95%CI, 1.11 to 1.35]). Compared to PSCs, IS patients at CSCs were more likely to receive IV rtPA or EVT therapy (adjusted OR, 1.31 [95%CI, 1.27 to 1.35]; adjusted OR, 1.43 [95%CI, 1.31 to 1.57]), more ICH and SAH patients received neurosurgery (adjusted OR, 1.70 [95%CI, 1.58 to 1.83]; adjusted OR, 1.29 [95%CI, 1.14 to 1.46]). While, CSCs had higher in-hospital mortality than PSCs (adjusted OR, 1.33 [95%CI, 1.23 to 1.43]), especially in ICH patients (adjusted OR, 1.77 [95%CI, 1.54 to 2.03]).

Conclusions: CSCs achieved higher care quality for stroke patients but lower risk-adjusted in-hospital mortality. The results might be instructive in improving the care quality in different types of stroke.