Importance Efficient care processes are crucial to minimize treatment delays and improve outcome after endovascular thrombectomy (EVT) in patients with ischemic stroke. A potential means to improve care processes is performance feedback. Objective To evaluate the effect of performance feedback to hospitals on treatment times for EVT. Design, Setting, and Participants This cluster randomized clinical trial was conducted from January 1, 2020, to June 30, 2022. Participants were consecutive adult patients with ischemic stroke who underwent EVT in 13 Dutch hospitals. No patients were excluded. Data analysis took place from March to May 2023. Intervention The intervention consisted of feedback on hospital performance using structure, process, and outcome indicators. Indicator scores were based on data from a national quality registry and compared with a benchmark. Performance feedback was provided through a dashboard for local quality improvement teams who developed and implemented improvement plans based on the feedback. Every 6 months, 3 to 4 randomly selected hospitals switched to the intervention condition. Main Outcome and Measures The primary outcome was time from door to groin puncture for all patients treated with EVT. Secondary outcomes included door-to-needle time, National Institutes of Health Stroke Scale (NIHSS) score at day 2, expanded Treatment in Cerebral Infarction (eTICI) score, and modified Rankin Scale (mRS) score at 3 months. The effect of the intervention was estimated with multivariable linear mixed models. Results A total of 4747 patients were included (intervention: 2431; control: 2316). Their mean (SD) age was 72 (13) years; 2337 (49.2%) were female and 2410 (50.8%) were male. The median (IQR) baseline NIHSS score was 14 (8-19). Median (IQR) door-to-groin puncture time under the intervention condition was 47 (25-71) minutes, compared with 52 (29-75) minutes under the control condition. The adjusted absolute reduction was 5 minutes (β = -4.8; 95% CI, -9.5 to -0.1; P = .04), corresponding to a relative reduction of 9.2% (95% CI, -18.3% to -0.2%). Conclusion and Relevance This study found that performance feedback provided through a dashboard used by local quality improvement teams reduced door-to-groin puncture time for EVT. Implementation of performance feedback in hospitals providing EVT can improve the quality of care for ischemic stroke. Trial Registration The Netherlands Trial Register: NL9090.

中文翻译：

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减少缺血性中风急性治疗时间的质量改进干预：一项整群随机临床试验。


重要性 高效的护理流程对于减少缺血性卒中患者血管内血栓切除术 （EVT） 后的治疗延误和改善预后至关重要。改进护理流程的一种潜在方法是绩效反馈。目的 评估向医院的绩效反馈对 EVT 治疗时间的影响。设计、设置和参与者 该整群随机临床试验于 2020 年 1 月 1 日至 2022 年 6 月 30 日进行。参与者是在 13 家荷兰医院接受 EVT 的连续成年缺血性中风患者。没有患者被排除在外。数据分析于 2023 年 3 月至 5 月进行。干预 干预包括使用结构、过程和结果指标对医院绩效的反馈。指标分数基于来自国家质量登记处的数据，并与基准进行比较。绩效反馈通过仪表板提供给当地质量改进团队，这些团队根据反馈制定和实施改进计划。每 6 个月，随机选择 3 至 4 家医院切换到干预条件。主要结局和措施 主要结局是所有接受 EVT 治疗的患者从门到腹股沟穿刺的时间。次要结局包括门到针时间、第 2 天的美国国立卫生研究院卒中量表 （NIHSS） 评分、扩展脑梗死治疗 （eTICI） 评分和 3 个月时的改良 Rankin 量表 （mRS） 评分。使用多变量线性混合模型估计干预的效果。结果 共纳入 4747 例患者 （干预： 2431;对照： 2316）。他们的平均 （SD） 年龄为 72 （13） 岁;女性 2337 例 （49.2%），男性 2410 例 （50.8%）。中位 （IQR） 基线 NIHSS 评分为 14 （8-19）。 干预条件下的中位 （IQR） 门到腹股沟穿刺时间为 47 （25-71） 分钟，而对照条件下为 52 （29-75） 分钟。调整后的绝对减少为 5 分钟 （β = -4.8;95% CI，-9.5 至 -0.1;P = .04），对应于相对减少 9.2%（95% CI，-18.3% 至 -0.2%）。结论和相关性 本研究发现，通过当地质量改进团队使用的仪表板提供的性能反馈减少了 EVT 的门到腹股沟穿刺时间。在提供 EVT 的医院实施绩效反馈可以提高缺血性中风的护理质量。试验注册 荷兰试验注册：NL9090。