Did a quality improvement collaborative make stroke care better? A cluster randomized trial

30 August 2018

Title

Did a quality improvement collaborative make stroke care better? A cluster randomized trial

Authors

Maxine Power, Pippa J Tyrrell, Anthony G Rudd, Mary P Tully, David Dalton, Martin Marshall, Ian Chappell, Delphine Corgié, Don Goldmann, Dale Webb, Mary Dixon-Woods, Gareth Parry

Published journal

Implementation Science

Abstract

Background: Stroke can result in death and long-term disability. Fast and high-quality care can reduce the impact of stroke, but UK national audit data has demonstrated variability in compliance with recommended processes of care. Though quality improvement collaboratives (QICs) are widely used, whether a QIC could improve reliability of stroke care was unknown.

Methods: Twenty-four NHS hospitals in the Northwest of England were randomly allocated to participate either in Stroke 90:10, a QIC based on the Breakthrough Series (BTS) model, or to a control group giving normal care. The QIC focused on nine processes of quality care for stroke already used in the national stroke audit. The nine processes were grouped into two distinct care bundles: one relating to early hours care and one relating to rehabilitation following stroke. Using an interrupted time series design and difference-in-difference analysis, we aimed to determine whether hospitals participating in the QIC improved more than the control group on bundle compliance.

Results: Data were available from nine interventions (3,533 patients) and nine control hospitals (3,059 patients). Hospitals in the QIC showed a modest improvement from baseline in the odds of average compliance equivalent to a relative improvement of 10.9% (95% CI 1.3%, 20.6%) in the Early Hours Bundle and 11.2% (95% CI 1.4%, 21.5%) in the Rehabilitation Bundle. Secondary analysis suggested that some specific processes were more sensitive to an intervention effect.

Conclusions: Some aspects of stroke care improved during the QIC, but the effects of the QIC were modest and further improvement is needed. The extent to which a BTS QIC can improve quality of stroke care remains uncertain. Some aspects of care may respond better to collaboratives than others.

Related links

You might also like...

Blog

Improving continuity of care in general practice: four lessons from the frontline

How can general practices balance continuity of care with the need to see a GP promptly? Angus Wiltshire explores four early ...

Briefing

The measurement maze

Our briefing suggests there's potential to make better use of quality measurement to improve quality of care.

Invitation to tender

ITT: Summative Evaluation of the Flow Coaching Academy Programme

The deadline for responses is 12.00 on Tuesday 5 November 2019.

Citation

Implementation Science 2014, 9:40 doi:10.1186/1748-5908-9-40 Published: 1 April 2014
Kjell-bubble-diagramArtboard 101 copy - only-wan.info

Get social

OnlyWan

What makes the NHS an #AnchorInstitution? The NHS is the UK’s biggest employer, with 1.5 million staff. The NHS…

Kjell-bubble-diagramArtboard 101 - only-wan.info

Work with us

We look for talented and passionate individuals as everyone at the OnlyWan has an important role to play.

View current vacancies
Artboard 101 copy 2 - only-wan.info

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more