Discussion
Stroke, TIPS, Thrombolysis
SECONDARY, STROKE
In this stepped-wedge cluster randomized clinical trial, we found that the STEP targeted quality intervention did not increase the overall rate of reperfusion therapy, the rate of a DNT within 60 minutes, or the rate of a DPT within 90 minutes. However, it increased the rate of reperfusion therapy in secondary hospital settings. The results showed that the problem-oriented, culturally adapted, targeted quality intervention might be more effective in secondary hospital settings, which may provide a direction for better resource allocation. According to the latest statistics, there are more than 10 000 secondary hospitals in China,There are several potential reasons why the STEP targeted quality improvement intervention was not effective for the improvement of reperfusion therapy overall but may be effective for secondary hospitals. First, because the effect of reperfusion therapy was confirmed in 5 milestone trials in 2015,We noted that fewer patients had a DPT within 90 minutes in the intervention period than in the control period, which may be explained by the higher proportion of patients having a DPT within 90 to 150 minutes in the intervention period (eFigure 3 in Several studies focusing on the improvement of thrombolysis have been launched. The TIPS (Thrombolysis Implementation in Pediatric Stroke) trial,