The emergency department quality improvement program improves the prognosis of patients with stroke in Taiwan: A nationwide cohort study

In 2012, Taiwan implemented the Emergency Department Quality Improvement Program (EDQIP) to enhance the quality of care for patients with acute ischemic stroke (AIS). This retrospective study evaluated the program's effectiveness using data from the National Health Insurance Research Database. AIS patients were classified into three groups: a pre-implementation group (2011), and a post-implementation group (2013-2015), which was further subdivided into EDQIP and non-EDQIP groups based on hospital participation and receipt of performance-based incentives. Among 169,434 AIS cases identified between 2013 and 2015, 64,574 patients met the inclusion criteria. Compared to the non-EDQIP group, patients in the EDQIP group demonstrated a 9% absolute reduction in the 30-day mortality rate (6% vs. 15%; adjusted hazard ratio [aHR] = 0.40, 95% confidence interval [CI] = 0.32-0.50) and a 2% absolute reduction in the 72-hour emergency department revisits rate (5% vs. 7%). Additionally, the EDQIP group showed a 9% absolute reduction in 30-day mortality rate compared to the pre-EDQIP group (6% vs. 15%; aHR = 0.39, 95% CI = 0.31-0.49). These findings suggest that the EDQIP may be associated with improved clinical outcomes for AIS patients in Taiwan and may serve as a model for similar quality improvement initiatives worldwide.