Quality Evaluation of Stroke Care and Treatment (China QUEST)

The ultimate goal of this research program is to improve the quality of stroke care in China.

Methods

The study will involve:

  • Assessing the appropriateness of acute stroke care, secondary prevention and rehabilitation against national and international guidelines
  • Understanding the factors (demographic, social, organisational and clinical) that contribute to the variations in (1) The quality (adherence to guideline-based treatments) and (2) Health outcomes after stroke
  • Determining the contribution of individual and community level socioeconomic measures on stroke outcomes
  • Developing and using methods to quantify the resource consequences of the different models of stroke care and study the determinants of cost, in particular the optimal balance of in-patient versus community-based stroke care
  • Developing a multifaceted strategy tailored to overcome identified barriers and improve stroke outcomes

The study will be undertaken in over 60 centres, with a mix of recruitment from Level 3 and non-Level 3 institutions, from 37 cities across several provincial regions of China. Each site will establish stroke registers at hospital- and medical-clinic centres based in separate urban, suburb and rural centres, as defined by geographical and service boundaries. These registers will use multiple overlapping sources including emergency departments, in-hospitals admissions lists, neurology wards, outpatient clinics, and hospital separations (morbidity) data to prospectively identify all new stroke cases in adults during the study period.

Data will be prospectively collected for each consecutive patient with a diagnosis of acute stroke (except cases of subarachnoid haemorrhage) admitted as an inpatient, or presenting to and followed up as an outpatient, at each participating centre. Data collection will include 100-300 (ie. a minimum of 100 and maximum of 300) patients from each of the participating sites, with a total of 8,000 patients overall (average 130 patients per centre).

All data will be entered directly into a server-based database via an internet website. Dedicated study monitors from the Coordinating Centre will visit each participating centre at least once to ensure accurate and complete data capture.

Data to be collected will include demographic, clinical, management and in-hospital outcomes on all registered cases. As well as an assessment at Baseline (ie. as soon as possible after notification) and at the time of hospital discharge (if admitted to hospital), all patients not known to have died will be followed-up at three and 12 months, for details on physical function (activities of daily living), mood, living arrangements, adherence to stroke prevention therapy, and use of health services will be recorded.

Project co-ordinators

  • Sun Jian
  • Emma Heeley
  • Alex Headley

Status

6510 patients were recruited between 1 July 2006 and nearly 30 November 2006. Baseline and three month follow up data have been collected and are currently being analysed. Follow-up of patients was completed in December 2007 and analyses are currently ongoing.

It is anticipated this study will form the basis for a future interventional study assessing the impact of various models of stroke care on patient outcome.

Further reading