Cluster randomized clinical trial, increasing the use of evidence-based practices through a multifaceted strategy. This study represents a project to improve the quality of care, through the incorporation of evidence-based interventions, in public tertiary hospitals and private hospitals in Brazil, Argentina and Peru. The BRIDGE_STROKE study has two phases: Phase 1: Prospective observational study (record) aimed at documenting the clinical practice of acute stroke management in patients seen in public and private hospitals. In addition, longitudinal follow-up of these patients was carried out until hospital discharge or the seventh day of hospitalization. After 30 days, data on mortality and degree of disability were also collected through visits or telephone calls. In phase 2: Cluster randomized clinical trial to test the effectiveness of a clinical practice improvement program in these hospitals. After the end of phase 2, all clusters will receive the multifaceted strategy. This study was approved by CONEP. During the first phase, 45 hospitals were included in the three countries involved and covering all regions of Brazil. In this phase, 941 patients were recruited. In the second phase, 36 hospitals were retained and thus randomized to the intervention group or the control group. During the execution of the study, meetings of researchers and visits to hospitals were carried out, both with the aim of training professionals involved in research activities themselves, as well as for training in the use of tools to improve clinical practice. The study methodology was published in the American Heart Journal and the study was completed in the second half of 2018 and the results presented at the main session of the American Heart Association’s annual congress in Chicago, USA and accepted for publication in JAMA Neurology.
Clinical Trials: https://clinicaltrials.gov/ct2/show/NCT02223273
Highlights of scientific production:
1: Machline-Carrion MJ, Santucci EV, Damiani LP, Bahit C, Málaga G, Pontes-Neto OM, Martins SCO, Zétola VF, Normilio-Silva K, de Freitas GR, Gorgulho A, De Salles A, da Silva BGP, Santos JY, de Andrade Jesuíno I, Bueno PRT, Cavalcanti AB, Guimarães HP, Xian Y, Bettger JP, Lopes RD, Peterson ED, Berwanger O. An international cluster-randomized quality improvement trial to increase the adherence to evidence-based therapies for acute ischemic stroke and transiente ischemic attack patients: Rationale and design of the BRIDGE STROKE Trial. Am Heart J. 2019 Jan;207:49-57. doi: 10.1016/j.ahj.2018.09.009. Epub 2018 Sep 30. PubMed PMID: 30415083.
Link: https://www.sciencedirect.com/science/article/abs/pii/S0002870318302783?via%3Dihub
2: Machline-Carrion MJ, Santucci EV, Damiani LP, et al. Effect of a Quality Improvement Intervention on Adherence to Therapies for Patients With Acute Ischemic Stroke and Transient Ischemic Attack: A Cluster Randomized Clinical Trial. JAMA Neurol. 2019;76(8):932–941. doi:10.1001/jamaneurol.2019.10122:
Link: https://jamanetwork.com/journals/jamaneurology/article-abstract/2732174