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Damush TM, Yu Z, Slaven J, Daggett VS, Sager D, Plue LD, Matthias M, Miech EJ, Williams LS. Stroke Care Team Associations with Acute Stroke Quality Improvement in Veterans Healthcare Administration. [Abstract]. Stroke; A Journal of Cerebral Circulation. 2015 Apr 1; 46(4):ATP351.
Background and Objective: We conducted standardized semi-structured baseline interviews to understand organizational constructs of stroke teams on a composite, acute stroke quality indicator across 11 VA Medical Centers (VAMCs). Methods: We conducted 104 semi-structured, in person, baseline interviews with clinical providers of acute stroke care services. Respondents were from nursing, emergency medicine, neurology, rehabilitation, inpatient care, medicine and quality management. We audiotaped the interviews, transcribed verbatim, and de-identified the data. Data were qualitatively coded using Nvivo software to tag segments of text into meaningful units based upon our Facilitating Best Practices Framework. Coders met regularly to review and consolidate emergent themes. Additionally a standardized team of chart abstractors collected 10 acute stroke quality indicators from a central location which comprised the composite. The follow up period included 6 (early response) and 12 (late response) months after a stroke collaborative. Results: At baseline, the VAMCs with a higher proportion of its respondents reporting regular monthly communication about stroke were associated with a late response in stroke quality improvement while sites with a lower proportion reporting regular monthly communication were associated with an early response in quality. VAMCs reporting the use of a designated nurse to promote guideline adherence and disease management were associated with an early response in quality. VAMCs reporting tracking their quality data and providing feedback to clinicians were associated with an early and late response in stroke quality improvement compared to those who did not. Finally, sites reporting the timely detection of acute stroke in the Emergency Department as a barrier at baseline were associated with no improvement in stroke quality. Conclusion: Our data suggests that clinical teams that wish to improve their quality may redesign their organization of care as structured to communicate regularly among their team, utilize nurses as designated for guideline adherence, track their quality data and provide feedback to clinicians, and triage presenting strokes in a timely manner.
