Nationwide “Hospital Emergent Capability Accreditation by Level-Stroke” Improves Stroke Treatment in Taiwan
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Background and Purpose Recombinant tissue plasminogen activator (rtPA) is one of the proventherapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, theMinistry of Health and Welfare, Executive Yuan, Republic of China, launched the project “HospitalEmergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment inTaiwan. The current study was performed to determine whether the project launched by thegovernment was effective in promoting rtPA therapy among AIS patients. Methods All participating hospitals were verified and designated as “heavy duty (HD),” “moderateduty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices(rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from2009 to 2014 as outcome measures. The data were analyzed using the χ2 test for significance. Results The number of certified hospitals progressively increased from 74 to 112 during the 6-yearperiod and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annualintravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. Theprotocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in theMeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was8.6%. Conclusions Initiation of the HECAL-Stroke project by the government significantly improved rtPAtreatment in Taiwan.
Abstract
Background and Purpose Recombinant tissue plasminogen activator (rtPA) is one of the proventherapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, theMinistry of Health and Welfare, Executive Yuan, Republic of China, launched the project “HospitalEmergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment inTaiwan. The current study was performed to determine whether the project launched by thegovernment was effective in promoting rtPA therapy among AIS patients. Methods All participating hospitals were verified and designated as “heavy duty (HD),” “moderateduty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices(rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from2009 to 2014 as outcome measures. The data were analyzed using the χ2 test for significance. Results The number of certified hospitals progressively increased from 74 to 112 during the 6-yearperiod and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annualintravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. Theprotocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in theMeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was8.6%. Conclusions Initiation of the HECAL-Stroke project by the government significantly improved rtPAtreatment in Taiwan.
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