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@ARTICLE{Scholten:186465,
      author       = {Scholten, N. and Pfaff, H. and Lehmann, H. C. and Fink,
                      Gereon Rudolf and Karbach, U.},
      title        = {{W}ho does it first? {T}he uptake of medical innovations in
                      the performance of thrombolysis in ischemic stroke patients
                      in {G}ermany: {A} study based on hospital quality data},
      journal      = {Implementation science},
      volume       = {10},
      issn         = {1748-5908},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {FZJ-2015-00539},
      pages        = {10},
      year         = {2015},
      abstract     = {BackgroundSince 2000, systemic thrombolysis has been the
                      only approved curative and causal treatment for acute
                      ischemic stroke. In 2009, the guidelines of the German
                      Society for Neurology were updated and the therapeutic
                      window for performing thrombolysis was extended. The
                      implementation of new therapies is influenced by many
                      factors. We analyzed the factors at the organizational level
                      that influence the implementation of thrombolysis in stroke
                      patients.MethodsThe data published by the majority of German
                      hospitals in their structured quality reports was assessed.
                      We calculated a regression model in order to measure the
                      influence of hospital/department-level characteristics
                      (e.g., teaching status, ownership, location, and number of
                      hospital beds) on the implementation of thrombolysis in 2006
                      (this is the earliest point in time that can be analyzed on
                      this data basis). In order to measure the effect of the
                      guideline update in 2009 on the thrombolysis rate (TR)
                      change between 2008 and 2010, we performed a Wilcoxon
                      signed-rank test and utilized a regression model.ResultsIn
                      2006, $61.5\%$ of a total of 286 neurology departments
                      performed systemic thrombolysis to treat ischemic strokes.
                      The influencing factors for the use of systemic thrombolysis
                      in 2006 were the existence of a stroke unit (+) and a
                      hospital size of between 500 and 1,000 beds (−). A
                      significant increase of the mean departmental TR
                      (thrombolysis rate) from $6.7\%$ to $9.2\%$ between 2008 and
                      2010 was observed after the guideline update in 2009. For
                      the departments performing thrombolysis in 2008 and 2010,
                      our analysis could not show any additional influencing
                      factors on a structural level that would explain the TR rise
                      during the period 2008–2010.ConclusionsBecause ischemic
                      stroke patients benefit from systemic thrombolysis, it is
                      necessary to examine possible barriers at the organizational
                      level that hinder the implementation. Our data shows that,
                      organizational factors have an influence on the
                      implementation of thrombolysis. However, the recent
                      guideline update resulted in a TR rise that occurred at all
                      hospitals, regardless of the measured structural conditions,
                      as our analysis could not identify any structural factors
                      that might have influenced the TR after the guideline
                      update.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {572 - (Dys-)function and Plasticity (POF3-572)},
      pid          = {G:(DE-HGF)POF3-572},
      typ          = {PUB:(DE-HGF)16},
      UT           = {WOS:000349184400001},
      pubmed       = {pmid:25582164},
      doi          = {10.1186/s13012-014-0196-7},
      url          = {https://juser.fz-juelich.de/record/186465},
}