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Abstract
The Paul Coverdell National Acute Stroke Registry prototypes baseline data collection
demonstrated a significant gap in the use of evidenced-based interventions. Barriers
to the use of these interventions can be characterized as relating to lack of knowledge,
attitudes, and ineffective behaviors and systems. Quality improvement programs can
address these issues by providing didactic presentations to disseminate the science
and peer interactions to address the lack of belief in the evidence, guidelines, and
likelihood of improved patient outcomes. Even with knowledge and intention to provide
evidenced-based care, the absence of effective systems is a significant behavioral
barrier. A program for quality improvement that includes multidisciplinary teams of
clinical and quality improvement professionals has been successfully used to carry
out redesign of stroke care delivery systems. Teams are given a methodology to set
goals, test ideas for system redesign, and implement those changes that can be successfully
adapted to the hospital's environment. Bringing teams from several hospitals together
substantially accelerates the process by sharing examples of successful change and
by providing strategies to support the behavior change necessary for the adoption
of new systems. The participation of many hospitals also creates momentum for the
adoption of change by demonstrating observable and successful improvement. Data collection
and feedback are useful to demonstrate the need for change and evaluate the impact
of system change, but improvement occurs very slowly without a quality improvement
program. This quality improvement framework provides hospitals with the capacity and
support to redesign systems, and has been shown to improve stroke care considerably,
when coupled with an Internet-based decision support registry, and at a much more
rapid pace than when hospitals use only the support registry.