Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

Marta Olivé-Gadea; Natalia Pérez de la Ossa; Tudor Jovin; Sonia Abilleira; Xavier Jiménez; Pere Cardona; Angel Chamorro; Alan Flores; Yolanda Silva; Francesc Purroy; Joan Martí-Fabregas; Ana Rodríguez-Campello; Josep Zaragoza; Jerzy Krupinski; David Canovas; Manuel Gomez Choco; Natalia Mas; Ernest Palomeras; Dolores Cocho; Josep M Aragonès; Carmen Repullo; Eduard Sanjurjo; Dolores Carrion; Esther Catena; Xavier Costa; M Cruz Almendros; Miquel Barceló; Jordi Monedero; Maria Rybyeva; Gloria Diaz; Marc Ribó

doi:10.1177/17474930221093523

Evolution of quality indicators in acute stroke during the RACECAT Trial: Impact in the general population

Int J Stroke. 2023 Feb;18(2):229-236. doi: 10.1177/17474930221093523. Epub 2022 May 4.

Authors

Marta Olivé-Gadea¹, Natalia Pérez de la Ossa², Tudor Jovin³, Sonia Abilleira⁴, Xavier Jiménez⁵, Pere Cardona⁶, Angel Chamorro⁷, Alan Flores⁸, Yolanda Silva⁹, Francesc Purroy¹⁰, Joan Martí-Fabregas¹¹, Ana Rodríguez-Campello¹², Josep Zaragoza¹³, Jerzy Krupinski¹⁴, David Canovas¹⁵, Manuel Gomez Choco¹⁶, Natalia Mas¹⁷, Ernest Palomeras¹⁸, Dolores Cocho¹⁹, Josep M Aragonès²⁰, Carmen Repullo²¹, Eduard Sanjurjo²², Dolores Carrion²³, Esther Catena²⁴, Xavier Costa²⁵, M Cruz Almendros²⁶, Miquel Barceló²⁷, Jordi Monedero²⁸, Maria Rybyeva²⁹, Gloria Diaz³⁰, Marc Ribó¹

Affiliations

¹ Stroke Unit, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
² Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
³ Neurology Department, Cooper University Health Care, Camden, NJ, USA.
⁴ Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain.
⁵ Emergency Medical Services of Catalonia, Barcelona, Spain.
⁶ Stroke Unit, Hospital Universitari Bellvitge, Barcelona, Spain.
⁷ Stroke Unit, Hospital Clínic, Barcelona, Spain.
⁸ Stroke Unit, Hospital Joan XIII, Tarragona, Spain.
⁹ Stroke Unit, Hospital Josep Trueta, Girona, Spain.
¹⁰ Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain.
¹¹ Stroke Unit, Hospital de Sant Pau, Barcelona, Spain.
¹² Stroke Unit, Hospital del Mar, Barcelona, Spain.
¹³ Neurology Department, Hospital Verge de la Cinta, Tortosa, Spain.
¹⁴ Neurology Department, Hospital Mútua Terrassa, Terrassa, Spain.
¹⁵ Neurology Department, Hospital Parc Tauli, Sabadell, Spain.
¹⁶ Neurology Department, Hospital Moisès Broggi, St Joan Despí, Spain.
¹⁷ Neurology Department, Althaia Xarxa Assistencial Universitària, Manresa, Spain.
¹⁸ Neurology Department, Hospital de Mataró, Mataró, Spain.
¹⁹ Neurology Department, Hospital General de Granollers, Granollers, Spain.
²⁰ Neurology Department, Consorci hospitalari de Vic, Vic, Spain.
²¹ Neurology Department, Fundació Sant Hospital, La Seu d'Urgell, Spain.
²² Neurology Department, Hospital Comarcal del Pallars, Tremp, Spain.
²³ Emergency Department, Hospital de Móra d'Ebre, Móra d'Ebre, Spain.
²⁴ Neurology Department, Consorci Sanitari Alt Penedès-Garraf, Spain.
²⁵ Emergency Department, Hospital de Figueres, Figueres, Spain.
²⁶ Internal Medicine, Hospital de Palamós, Palamós Spain.
²⁷ Emergency Department, Hospital de Cerdanya, Puigcerdà, Spain.
²⁸ Hospital d'Igualada, Igualada, Spain.
²⁹ Emergency Department, Hospital d'Olot, Olot, Spain.
³⁰ Emergency Department, Hospital de Campdevànol, Campdevànol, Spain.

PMID: 35373657
DOI: 10.1177/17474930221093523

Abstract

Background: Acute ischemic stroke patients not referred directly to a comprehensive stroke center (CSC) have reduced access to endovascular treatment (EVT). The RACECAT trial is a population-based cluster-randomized trial, designed to compare mothership and drip-and-ship strategies in acute ischemic stroke patients outside the catchment area of a CSC.

Aims: To analyze the evolution of performance indicators in the regions that participated in RACECAT.

Methods: This retrospective longitudinal observational study included all stroke alerts evaluated by emergency medical services in Catalonia between February 2016 and February 2020. Cases were classified geographically according to the nearest SC: local SC (Local-SC) and CSC catchment areas. We analyzed the evolution of EVT rates and relevant workflow times in Local-SC versus CSC catchment areas over three study periods: P1 (February 2016 to April 2017: before RACECAT initiation), P2 (May 2017 to September 2018), and P3 (October 2018 to February 2020).

Results: We included 20603 stroke alerts, 10,694 (51.9%) of which were activated within Local-SC catchment areas. The proportion of patients receiving EVT within Local-SC catchment areas increased (P1 vs. P3: 7.5% (95% confidence interval (CI), 6.4-8.7) to 22.5% (95% CI, 20.8-24.4) p < 0.001). Inequalities in the odds of receiving EVT were reduced for patients from CSC versus Local-SC catchment areas (P1: odds ratio (OR) 3.9 (95% CI, 3.2-5) vs. P3: OR 1.5 (95% CI, 1.3-1.7) In Local-SC, door-to-image (P1: 24 (interquartile range (IQR) 15-36), P2: 24 (15-35), P3: 21 (13-32) min, p < 0.001) and door-to-needle times (P1: 42 (31-60), P2: 41 (29-58), P3: 35 (25-50) p < 0.001) reduced. Time from Local-SC arrival to groin puncture also decreased over time (P1: 188 [151-229], P2: 190 (157-233), P3: 168 (127-215) min, p < 0.001).

Conclusion: An increase in EVT rates in Local-SC regions with a significant decrease in workflow times occurred during the period of the RACECAT trial.

Keywords: Stroke network; territorial disparities; workflow.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Brain Ischemia* / therapy
Endovascular Procedures*
Humans
Ischemic Stroke*
Quality Indicators, Health Care
Retrospective Studies
Stroke* / epidemiology
Stroke* / therapy
Thrombectomy
Thrombolytic Therapy / methods
Treatment Outcome