Use of Performance Indicators for Assessment of Quality of Care of Acute Stroke Patients in a Health Insurance Hospital in Alexandria

Abstract

Performance indicators are usually one component of an overall strategy for quality improvement in health care. However, their use depends on adequate documentation in medical records. The aim of this study is to assess the quality of care provided to hospitalized stroke patients in Health Insurance hospital in Alexandria using performance indicators, and to determine the feasibility of abstraction of indicator data based on the level of documentation in medical records. Data elements for ten performance indicators were abstracted through retrospective review of randomly selected 170 records of acute stroke patients [out of 850 discharges] during the year 2003-2004. Results indicated that documentation in medical records was adequate for computing five of the ten performance indicators, namely, use of antithrombotic medication within 48 hours of hospitalization, prescription of anticoagulant therapy for patients with atrial fibrillation, prescription of antithrombotic on discharge, lipid profile during hospitalization, and plan for rehabilitation, with figures ranging between 71.2% and 14.5%. Due to the deficiency of recorded data, it was not possible to reliably compute the following five indicators: deep vein prophylaxis, tissue plasminogen activator considered, screen for dysphagia, stroke education, and adult smoking cessation advice. It was concluded that management of stroke patients needs to be better documented, along with more provider education for proper management of stroke.