Phase 1: An observational study ( registry) will be conducted with the objective of documenting the practice of stroke treatment in brazilian and latin american hospitals. Phase 2: A cluster randomized trial aiming to evaluate the effect of a multifaceted strategy to increase evidence based treatments usage for stroke patients. The hospitals will be randomized into two groups: the multifaceted strategy group and the usual care group.
Study Objective: The purpose of this study is to evaluate a multifaceted strategy to increase evidence based therapies for patients with acute ischemic stroke. Study Population; Patients with suspected stroke or transient ischemic attack (TIA) with symptoms lasting up to 24h hours. Quality Improvement Multifaceted Intervention: The strategy includes a simulation based team training, case manager, check lists, reminders and educational material.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,624
1. Simulation Based Team Training 2. Case Manager: a trained person who works in the hospital and is responsible for ensuring the usage of all interventions 3. Reminders - 4. Check lists - decision support algorithm 5. Distribution of educational materials: guidelines and recommendations for best practices
Brazil
São Paulo, Brazil
Frequency of Evidence Based Strategies
For phase 1: Proportion of prescription of evidence-based strategies. in the first 48 hours and prior to discharge
Time frame: Discharge or 7 days after admission
Composite Adherence Score
Composite Adherence Score: defined as the sum of usage of evidence based therapies in the first 48 hours and at discharge among the patients' total eligible opportunities. For this purpose, patients with contraindications (which are specific for each endpoint) were excluded from the denominators. Evidence based therapies in the first 48 hours include: antithrombotics within 48 hours of admission, use of recombinant Plasminogen Activator (Rt-PA)in patients who arrive at the hospital within 3.5 hours of symptom onset and who are treated within 4.5 hours of symptom onset, dysphagia screening, pre-deep venous thrombosis prophylaxis, door to needle time \< 60 minutes, dysphagia screening). Discharge Therapies include: antithrombotics, lipid lowering agents in patients with LDL 100 or not documented, anticoagulants for atrial fibrilation or flutter, assessment for rehabilitation and smoke cessation education
Time frame: Discharge or 7 days after admission
"All or None" Quality Measures
Proportion of prescription of evidence-based strategies in the first 48 hours and at discharge "All or none" measures including the evidence based therapies in the first 48h: antithrombotics, use of recombinant Plasminogen Activator (Rt-PA)in patients who arrive at the hospital within 3.5 hours of symptom onset and who are treated within 4.5 hours of symptom onset, dysphagia screening, pre-deep venous thrombosis prophylaxis, door to needle time \< 60 minutes, dysphagia screening). Discharge Therapies include: antithrombotics, lipid lowering agents in patients with LDL 100 or not documented, anticoagulants for atrial fibrilation or flutter, assessment for rehabilitation and smoke cessation education
Time frame: Discharge or 7 days after admission
Additional Strategies
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Proportion of usage of the additional strategies: use of recombinant Plasminogen Activator (Rt-PA), anti-hypertensive agents, and door to needle time\< 45 min)
Time frame: Discharge or 7 days after admission
Total Mortality
In hospital and 90 days mortality
Time frame: Discharge or 7 days after admission and 90 days
Disability
Degree of disability (measured by the Modified Rankin Scale) at discharge and in 90 days.
Time frame: 90 days
Stroke Recurrence
Number of patients presenting a new stroke in 90 days
Time frame: 90 days