WSO - March 2023 - 310

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International Journal of Stroke 18(3)
Functional assessment plays a crucial role in subsequent
correct treatment decisions and patient outcomes. Our
study suggested that the functional evaluation of stroke
patients has not received enough attention. Blood lipid
determination is a QI related to blood lipids. Some studies
have confirmed that the use of statins and other lipid-lowering
drugs can reduce stroke mortality; timely evaluation
of blood lipid function can detect stroke patients with dyslipidemia
earlier.20 Guidelines have pointed out that 45%
(30-65%) of patients with stroke have dysphagia, which
may trigger complications that impair functional recovery.21
The implementation of these QIs rarely has adverse
side effects, and given the cost-effectiveness, these indicators
should be used more widely.
Our study has several limitations in this study. First,
the results from this study have not directly shown that
not obtaining optimal care is responsible for avoidable
adverse prognoses or deaths. Nor has this study provided
direct evidence that examining indicators is an effective
way to close the gap between hospitals. These are portions
of complex causal pathways, and inference of causality is
limited by the retrospective, cross-sectional nature of the
study. Second, there may have been unknown confounding
variables not available in the dataset that may have
impacted hospital effect, thus a more in-depth case-mix
adjustment is warranted. Third, our study focused on the
tertiary hospitals. Rural hospitals were not included. Thus,
we could not examine differences in quality of stroke care
between rural and urban areas. Fourth, interpretation of
the results is restricted to in-hospital because we were
unable to obtain outpatient follow-up information and
were unable to determine the impact of better adherence
on outpatient mortality.
Conclusion
In this analysis of 123,259 AIS patients at 109 China tertiary
hospitals, we identified key QIs that influenced the
quality disparity. We found that QIs associated with emergency
screening and functional assessment significantly
contributed to the improvement in HPCP for stroke patients,
which suggested that closing the gap in HPCP between hospitals
and improving the care quality of stroke could give
these QIs priority in present healthcare setting.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article: This
work was supported by the National Natural Science Foundation
of China (82173614 to M.L.).
International Journal of Stroke, 18(3)
ORCID iDs
Jingkun Li
Chao Wang
Meina Liu
https://orcid.org/0000-0001-8731-2872
https://orcid.org/0000-0003-0523-436X
https://orcid.org/0000-0002-3790-8069
Supplemental material
Supplemental material for this article is available online.
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https://www.orcid.org/0000-0001-8731-2872 https://www.orcid.org/0000-0003-0523-436X https://www.orcid.org/0000-0002-3790-8069
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