Improvement of Adherence to Performance Measures in Patients With Acute Ischemic Stroke by Using Automatic Extraction of Electronic Medical Records: Baseline Characteristics of the Network of Shanghai Stroke Service System (4S)

Introduction: Several stroke quality control and outcome projects have demonstrated the success in improving stroke care quality through structured process. However, Chinese healthcare systems are challenged with its overwhelming numbers of patients, limited resources and large regional disparities. This study aims to Improve quality of stroke care to address regional disparities. Methods: The Shanghai Stroke Service System (4S) was established as a regional network for stroke care quality improvement in Shanghai. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Thirty-six hospitals including 10 regional stroke centers and 25 district stroke centers. Registry began enrolling all patients with diagnosed acute ischemic stroke (AIS) in 2017. Primary outcome is to evaluate the differences in quality metrics performance before and after the implementation structured quality improvement process. Results: Among 14461 patients with AIS registered, patient’s average age was 73 years old with 4958 women (34.2%) in 2017. Compared to the data from the previous registry, web-based database enrolled more patients (3175 in 2014, 4815 in 2015, 12387 in 2016, p<0.001). With the best use of resource(Table1), AIS patients in 4S were more likely to receive performance measures than those of previous registry (composite measure 83%, Figure 1A). A trend of gradually decreased hospital mortality and rate of unplanned re-admission within 30 days was observed in 4S hospitals (Figure 1B). Conclusions: The study has helped to identify areas stroke care deficiencies and improvement. Despite of challenges of healthcare in China, 4S proved the feasibility and potentially effective as a regional stroke network model for quality improvement. This model could be duplicated at other large cities or regions in China. Clinicaltrials.gov Identifier NCT02735226