Quality Improvement in Stroke Prevention (QUISP)

Study Overview
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Brief Summary
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Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke: Treatment with statins, Control of hypertension, and Anticoagulation in patients with atrial fibrillation.

Detailed Description
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There are several proven strategies for prevention of recurrent ischemic stroke, including use of statins, treatment of hypertension, and anticoagulation in patients with atrial fibrillation. Preliminary analyses suggest that only 9-15% of Kaiser Permanente Northern California's ischemic stroke patients receive optimal care for secondary prevention of stroke. The purpose of this study is to determine whether or not a quality improvement (QI) intervention can improve the care received by stroke patients. This project consists of a randomized trial of standardized stroke discharge order forms to improve adherence with best practices in secondary stroke prevention. The primary research question is: Is a secondary prevention intervention, focused on implementation of standardized pre-printed discharge orders for hospitalists, effective at increasing utilization of the following evidence-based treatments 6 months after discharge for ischemic stroke: (1) treatment with statins, (2) control of hypertension, and (3) anticoagulation in patients with atrial fibrillation. The primary outcome will be the proportion of patients receiving optimal treatment, as defined by these three goals. The impact of the intervention will be measures as a change after-to-before at intervention hospitals compared to non-intervention (control) hospitals, with the institution as the unit of analysis. Secondary analyses will evaluate the impact of the intervention on each of these components and on 6-month and 1-year rates of mortality, readmission for stroke, and costs of care after discharge.

Official Title
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Secondary Prevention After Ischemic Stroke: A Trial of an Evidence-Based System-Wide Intervention

Conditions
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Ischemic Stroke

Intervention / Treatment
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* Drug: Optimal treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ischemic stroke Kaiser-Permanente Health Plan Member with Pharmacy Benefit Discharged alive to home Exclusion Criteria: tpA patients Hemorrhagic stroke TIA Significant comorbidities

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Single


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Optimal treatment|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medication utilization |  |  | 
| Best Practices |  |  | 
| Recurrent stroke |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality |  |  | 
| Morbidity |  |  | 
| Cost |  |  | 
| Hospital readmission |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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CVA, Ischemic stroke