Improving In-hospital Stroke Service Utilisation in China

Improving In-hospital Stroke Service Utilisation (MISSION) in China: A Cluster Randomised Trial of Interventions to Shorten Door to Needle Times

Shaoxing Second Hospital, Haining People' s Hospital, Haiyan People' s Hospital, Huzhou No.1 People' s Hospital, Jiashan No.1 People' s Hospital, Ningbo Medical Center Lihuili Hospital, Tongxiang No.1 People' s Hospital, First Affiliated Hospital of Wenzhou Medical University, Yiwu Central Hospital, Yongkang No.1 People' s Hospital, Yuyao People' s Hospital, Deqing People' s Hospital, Dongyang People' s Hospital, Jinhua People' s Hospital, Lishui People' s Hospital, Lin' an People' s Hospital, Longquan People' s Hospital, Qingtian People' s Hospital, Shaoxing Central Hospital, Wenzhou Central Hospital, Xiangshan No.1 People' s Hospital, The Central Hospital of Lishui City

A cluster randomised controlled trial will be conducted, using hospital as randomisation unit. Hospitals in Zhejiang Province, China, will be randomised into two arms (1:1): an intervention arm and a control arm. Hospitals in the intervention arm will receive a multi-components intervention based on the Behaviour Change Wheel model, whereas hospitals in the control arm will receive no intervention and maintain existing care. The randomisation will be conducted after one-year baseline data collection. The following baseline data will be used for randomisation match: hospital classification, beds in stroke centre, thrombolysis patient number, and percentage of patients receiving thrombolysis within 60 minutes of stroke onset. Hospitals with no stroke centre or with <20 cases received thrombolysis per year will be excluded from the study. The primary outcome will be difference between intervention arm and control arm in the percentage of patients receiving thrombolysis within 60 minutes of stroke onset on the follow-up stage (post-intervention).

Hospitals in the intervention arm will receive a multi-components intervention based on the Behaviour Change Wheel model

Interventions are developed on a psychological model, the Behaviour Change Wheel (BCW) .The fundamental of BCW consists of three essential elements: capability, motivation, and opportunity. Improving individual's capability, providing motivation, and increasing opportunities are goals of behaviour change intervention. To achieve the goals, 9 intervention components have been proposed in the BCW framework, and 6 components will be used in current study.

Difference between intervention arm and control arm in the percentage of patients receiving thrombolysis within 60 minutes of stroke onset on the follow-up stage

modified Rankin Scale score at discharge, on which scores range from 0 (no neurologic deficit) to 6 (death)

Intracranial hemorrhage at 24 hours associated with an increase of ≥4 points of NIHSS score from baseline, according to European Cooperative Acute Stroke Study (ECASS) II trial

Score of 0 to 1 on the modified Rankin Scale, on which scores range from 0 (no neurologic deficit) to 6 (death)

Inclusion Criteria: AIS patients receiving IVT within 4.5 hours Exclusion Criteria: Patients who are not willing to attend this trial

Zhong W, Lin L, Gong X, Chen Z, Chen Y, Yan S, Zhou Y, Zhang X, Hu H, Tong L, Cheng C, Gu Q, Chen Y, Yu X, Huang Y, Yuan C, Lou M; MISSION investigators. Evaluation of a multicomponent intervention to shorten thrombolytic door-to-needle time in stroke patients in China (MISSION): A cluster-randomized controlled trial. PLoS Med. 2022 Jul 5;19(7):e1004034. doi: 10.1371/journal.pmed.1004034. eCollection 2022 Jul.

Wang J, Gong X, Zhong W, Zhou Y, Lou M. Novel Prehospital Triage Scale for Detecting Large Vessel Occlusion and Its Cause. J Am Heart Assoc. 2021 Sep 7;10(17):e021201. doi: 10.1161/JAHA.121.021201. Epub 2021 Aug 21.