Abstract WP355: Quality of Stroke Care Between 2008 and 2014 in Korea: Analysis of the Nationwide Acute Stroke Quality Assessment Program

Abstract

Introduction: Higher quality of stroke care based on guideline recommendations is associated with better clinical outcomes. However, there is limited information about contemporary status of quality of stroke care and its association with improvements in clinical outcomes in Korea. Methods: This retrospective observational study was performed by analyzing the data of the patients admitted to 258 acute stroke care hospitals covering an entire country from the Acute Stroke Quality Assessment Program, which was carried out by the Health Insurance Review and Assessment Service from 2008 to 2014. Six GWTG-Stroke performance measures (except prophylaxis for venous thromboembolism) were applied to evaluate quality of stroke care in Korea. The primary outcome variable was defect-free care, which is defined as the proportion of patients who received all of the performance measure interventions for which they were eligible. Multivariable analysis was performed to evaluate the association between defect-free care and clinical outcomes. Temporal trends and hospital variations of performance measures were evaluated. Results: Among 43 793 patients (mean age, 67±14 years; male, 55%) with acute stroke during the study period, 31 915 (72.9%) patients were hospitalized due to ischemic stroke or transient ischemic attack. The proportion of defect-free care for stroke steadily increased throughout the study period: from 80.2% in 2008 to 92.1% in 2014. Defect-free care was given more frequently in patients admitted to hospitals with a higher volume of stroke cases or intravenous thrombolysis administration, and stroke units. Patients who received defect-free care were associated with discharge to home (adjusted odds ratio 1.96; 95% CI 1.78-2.16) and 1-year survival (adjusted odds ratio 0.41; 95% CI 0.37-0.46). Only 60% of stroke patients were managed in hospitals with a certified stroke unit, and the distribution of certified stroke units showed an urban-to-rural gradient. Conclusions: The quality of stroke care in Korea has improved over time, and defect-free care was associated with discharge to home and 1-year mortality. There are still opportunities to improve the quality of stroke care in Korea by development of stroke networks in Korea.