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Table 4 Quality monitoring

From: Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials

Study Patient Intervention/Comparator Outcomes Results
Parker 2012 Patients with stroke I: Studies that evaluated the relationship between compliance with ≥ 2 quality metrics and patient centered outcomes or the public reporting of stroke metrics and QI activity, quality of care and patient centered outcomes. Mortality, ADL function, adverse events/complications, QOL, patient satisfaction There is some evidence of positive associations between stroke metric compliance and improved outcomes however, there are few high quality studies. Information on the impact of public reporting of stroke quality metric data is extremely limited
Design: SR
Size: 16 studies
Setting: Acute All levels of severity
AMSTAR: 3/11     
Dirks 2012 Patients with stroke I: An intervention based on the ‘Breakthrough Series’ model to increase the rates of thrombolysis in acute stroke wards Treatment rates of tPA, time from event to admission, death or disability, QOL Thrombolysis rates in the intervention group rose earlier and remained higher than the control group.
C: Usual care
Design: cluster RCT
Size: N = 5515 patients from 12 hospitals
Setting: Acute
PEDro: 7/10     
Falconer 1993 Patients with stroke I: Care was provided based on an interdisciplinary care model and the use of a ‘critical path method (CPM) to plan care and discharge. The CPM provided the team with information and continuous feedback Length of hospital stay, hospital charges, ADL function, patient satisfaction The groups received comparable type, intensity and duration of treatment and there was no significant difference between groups in length of stay and hospital charges
Design: RCT
Size: N = 128
Setting: Rehabilitation
United States
PEDro: 4/10
   C: Usual care in which the care model was more multidisciplinary and a CPM was not used.   
Hinchey 2010 Patients with stroke I: Multifaceted intervention targeted towards improving key performance measures: door-to-needle time for TPA, dysphagia screening, DVT prophylaxis and warfarin treatment for AF. The intervention included meetings, identification of barriers, reminder systems, education, audit and feedback. Difference in post-intervention adherence rates The intervention group had a significantly higher rate of patients with AF discharged on warfarin however there were no other significant differences between groups.
Design: Controlled trial
Size: N = 2071 pre-intervention patients and 1240 post-intervention patients
Setting: Acute
United States C: Audit and feedback alone
D & B: 13/26     
Johnston 2010 Patients with stroke I: Standardised stroke discharge orders on adherence to 3 practices: normalisation of blood pressure, statin treatment and anticoagulation for AF Management of these outcomes at 6 months There was no significant impact of intervention at the hospital level.
Design: cluster RCT
Size: 12 hospitals (3361 patients)
Analysis at the patient level found that rates of optimal treatment increased at intervention hospitals whereas there was no change at control hospitals. Improvements were primarily related to increased statin use and improved blood pressure control.
Setting: Acute C: Usual care (no standardised orders)
United States
PEDro: 8/10     
Lakshminarayan 2010 Patients with stroke I:Intervention to improve care quality as measured by Ten performance measures(eg tPA use, smoking cessation counselling, PT and OT evaluation or treatment <48 hours) There were no significant differences between groups
Design: cluster RCT 10 key performance measures. Intervention included receipt of a report on baseline quality, the use of clinical opinion leaders and assistance from study personnel to implement changes and overcome barriers
Size: 19 hospitals (1211 patients)
Setting: Acute
United States
PEDro: 8/10
   C: Received report on baseline quality only   
Strasser 2008 Patients with stroke I: Both groups received summaries of their team’s performance on process measures. The intervention group received team training provided over 6 months. Comprised a 2.5 day workshop for team leaders to develop team problem-solving strategies, written action plans to address team process problems and support to implement action plans ADL function, community discharge and length of stay Patients in the intervention group improved significantly more on the FIM motor score than the control group (13.6% absolute difference in percentage of patients gaining more than 23 points)
Design: cluster RCT
Size: N = 487 patients
Setting: Rehabilitation
United States
PEDro: 5/10
   C; Received the summary of performance only