Research Progress of the Construction and Quality Control of Stroke Center

doi:10.3969/j.issn.1673-5765.2023.09.002

Abstract

Abstract: The construction of stroke centers and quality control has been a hot topic in the field of stroke treatment in recent years. China’s construction of stroke centers, through the integration of medical resources and multidisciplinary collaboration, has formed a regional organized stroke treatment network that integrates pre-hospital identification and transfer, acute phase treatment, early rehabilitation, secondary prevention, follow-up education, quality inspection and improvement. A standardized, efficient, and standardized system for stroke treatment and quality control has been established, which plays a crucial role in standardizing and enhancing the diagnosis and efficiency of stroke in medical institutions, promoting the improvement of medical service quality, and reducing the burden of disease. The construction of the emergency map focuses on how to reduce time delay in emergency response and acute phase treatment, including pre-hospital identification and emergency dispatch. China has gradually built a “national-province-prefecture-level city” three-tier stroke emergency map system, constructing a “regional stroke emergency map” centered on prefecture-level cities. The construction of China’s stroke emergency green channel has developed rapidly in the past 10 years. Medical institutions at all levels have established multidisciplinary teams for acute stroke diagnosis and treatment, changed the patient flow from serial to parallel, carried out detailed quality inspections and continuous improvements, and gradually improved efficiency using information technology, effectively reducing in-hospital delays, increasing thrombolysis rates, and improving clinical efficacy. Primary medical institutions face the vast number of stroke patients more directly. However, due to disadvantages in medical hardware, talent reserves, and institutional mechanisms, it is extremely challenging to bridge the “last mile” of stroke treatment. The proactive exploration conducted in Henan province is worth referencing and learning from. Stroke units can significantly improve the clinical outcomes of acute stroke patients. Their construction covers acute phase treatment, secondary prevention, early rehabilitation, and health education for stroke patients, requiring enhanced multidisciplinary collaboration. Mobile stroke units are an innovative model that extends stroke treatment to the pre-hospital stage. They can significantly shorten the time from onset to thrombolysis decision and have high safety. Their promotion and application are crucial for improving the treatment level of stroke patients. In terms of quality control of stroke centers, China has initially formed a three-tier quality control network of “national-province-prefecture-level city”, forming a relatively comprehensive quality control network system covering different levels nationwide. However, facing significant socio-economic development disparities, the future construction of stroke centers and quality control work remains a long journey ahead.

Key words: Stroke center; Quality control; Stroke unit; Green channel; Mobile stroke unit

摘要： 卒中中心建设及质量控制是近年来卒中救治领域的热点话题。我国的卒中中心建设通过医疗资源整合，多学科协作，形成了一个集院前识别与转运、急性期救治、早期康复、二级预防、随访宣教、质量检测及改进于一体的区域组织化卒中救治网络，建立了一套标准、高效、规范的卒中救治及质量控制体系，对规范和提升医疗机构卒中诊疗和效率，促进医疗服务质量改进，降低疾病负担起到了重要作用。急救地图建设着眼于如何在急救响应及急性期治疗环节减少包括院前识别、急救派遣等环节的时间延误，我国逐步构建了“国家-省-地级市”三级卒中急救地图体系，建设以地级市为中心的“区域卒中急救地图”。我国卒中急诊绿色通道建设近10年来发展迅速。各级医疗机构通过成立急性卒中诊治多学科团队，就诊流程从串联变并联，开展精细化质量检测及持续改进，借助信息化手段逐步提升效率，有效缩短院内延误，提高了溶栓率，改善了临床疗效。基层医疗机构更为直接面对广大卒中人群，但由于在医疗硬件、人才储备、体制机制等各方面的劣势，打通卒中救治的“最后一公里”困难重重。河南省进行的积极探索值得借鉴参考。卒中单元可以显著改善急性卒中患者的临床结局，其建设涵盖了卒中患者的急性期治疗、二级预防、早期康复和健康宣教等环节，需要加强多学科协作水平。移动卒中单元是一种将卒中救治延伸到院前阶段的创新模式，可以显著缩短发病到决定溶栓的时间，并且安全性较高，其推广应用对于提高卒中患者的救治水平具有重要意义。在卒中中心质控方面，我国初步形成“国家-省-地级市”的三级质控网络，形成覆盖全国不同层级的较健全的质控工作网络体系，但面对巨大的社会经济发展差异，未来卒中中心建设及质量控制工作依然任重道远。

关键词: 卒中中心; 质量控制; 卒中单元; 绿色通道; 移动卒中单元

GAO Yuan, LIU Kai, LI Yapeng, YANG Zongyu, LI Yusheng, SONG Bo, XU Yuming. Research Progress of the Construction and Quality Control of Stroke Center[J]. Chinese Journal of Stroke, 2023, 18(9): 979-985.

高远, 刘凯, 李亚鹏, 杨宗豫, 李玉生, 宋波, 许予明. 卒中中心建设及质量控制研究进展[J]. 中国卒中杂志, 2023, 18(9): 979-985.

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