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Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents.

In many regards, this trial represents the best of evidence-based quality improvement efforts—the improvement in health outcomes is often greater than what would have been expected from the individual components alone. An outcome of the trial by Wang et al is the proof that effective stroke interventions can be implemented in China where the burden of stroke is the highest in the world. Trials like this one leave a lasting legacy because the coaching and follow-up and the demonstration that data collection can lead to better outcomes with practice change will leave each of the intervention hospitals with a platform of good-quality stroke care and a mechanism to keep improving. Similar to the challenge of providing a novel drug to patients after a trial ends, a new dilemma that arises for the trialists is how to get the nonintervention hospitals up to the same level of care as the intervention hospitals. A major challenge is the sustainability of these kinds of interventions. Intensive quality improvement is just not practical for long periods; lower level embedded improvement needs to be built into the culture of a hospital, written into job descriptions, and identified as a deliverable in employment contracts to make continuous improvement possible and likely. In addition, the finer details of the intervention must be made available to others. A “teach the teacher” model may apply in distributing this kind of intervention widely. Overall, this randomized clinical trial by Wang et al has achieved its broad objective of both providing both stroke evidence and implanting practice change in 20 hospitals. The challenge now is to sustain that level of quality improvement at these hospitals, and expand this approach to other centers providing care for patients with acute stroke.