International Journal of Stroke | 2019
Advanced clinical education for stroke physicians in China: The ACTION and SCA models
Abstract
Background – The challenge of stroke in China Stroke is the leading cause of death in China. Its incidence has been increasing by 8.7% per year and its age of onset is increasingly younger. It is a costly disease, accounting for 4.13% of total medical expenses in China. There are 2.4 million new stroke patients, and 1.1 million deaths attributable to stroke each year. There are 11.1 million stroke survivors with various degrees of disability. China also has the largest population at high risk of stroke, and risk factor control is much lower than that of developed countries in Europe and America. This disease has significantly impacted the health and quality of life of Chinese people and posed a heavy medical and socioeconomic burden to stroke patients, their carers, and society. The Chinese Stroke Association and neurologists have been endeavoring to improve the quality of stroke care. Recently, the Chinese government has partnered with academics in implementing stroke prevention and management measures which have led to improvements in stroke management, resulting in a decrease in stroke-related mortality. By evaluating 13 performance metrics (derived from guidelines), it is evident that the composite score (as the total number of interventions actually performed among eligible patients divided by the total number of recommended interventions among eligible patients) has increased from 0.63 in the period of 2007–2008 to 0.76 in the period of 2012–2013, with 9 metrics improved in the latter period. Compared with 1985, the incidence and prevalence of stroke have increased to 247/100,000, and 1115/100,000, respectively, but the mortality rate has decreased to 115/100,000 in the period of 2012–2013. In the past decade, the door to needle time for recombinant tissue plasminogen activator (rt-PA) thrombolysis has decreased from 122min to 51min in those hospitals, whereby optimization of stroke management time metrics has been adopted. The average door to needle time is 74min, a 26% reduction from 2008 to 2012. The percentage of patients with a door to needle time less than 60min has increased from 6.5% to 34.1%. Impressively, the percentage use of rt-PA thrombolysis among acute ischemic stroke patients has increased from 1.9% to 9.2%. Clinical stroke research led by Chinese researchers is gaining more prominence. However, these accomplishments are only achieved by a limited number of hospitals and universities. Despite these advances, the majority of physicians in hospitals still lack systematic understanding of stroke and many do not use standardized protocols for stroke management. It is common to experience a delayed response after hospital arrival and low rt-PA thrombolysis rate. Therefore, it is imperative to increase the capability of clinicians to manage stroke using evidence-based guidelines. Particular goals should be to optimize the protocol for urgent stroke management, to increase the awareness of stroke unit management and secondary prevention, and to implement rehabilitation procedures after stroke. To meet these challenges, leading Chinese neurologists have collaborated with their counterparts in developed countries to initiate the ACTION (Australia China Training Initiative of Neurology) and the SCA (Stroke Care Academy) programs, which aimed to provide advanced neurological education models for Chinese doctors, focused on stroke and other common neurological diseases.