Quality Of Stroke Care Research Articles

Clinical Performance Measures for Adults Hospitalized With Intracerebral Hemorrhage: Performance Measures for Healthcare Professionals From the American Heart Association/American Stroke Association.

To work toward the goal of building healthier lives, free of cardiovascular diseases and stroke, the American Heart Association (AHA) and American Stroke Association (ASA) have developed a multifaceted strategy for improving the quality of care for stroke. A key feature of this strategy is the development of professional guidelines for evidence-based stroke care. Recommendations are provided for acute management, primary and secondary prevention, rehabilitation, stroke systems of care, and other domains of stroke care.1–4 The strength of the evidence supporting these recommendations is given, according to a specified grading system. For many aspects of care, there is widespread consensus that the intervention is beneficial, usually supported by strong scientific evidence including randomized controlled trials. Professional guidelines improve the delivery of evidence-based care; however, despite these guidelines, gaps between best evidence-based practice and actual practice persist.5 To close these gaps in quality of care, several organizations have developed systems to allow practitioners and healthcare organizations such as hospitals to quantify the quality of their care through performance measures. A performance measure is defined by the Agency for Healthcare Research and Quality as a “mechanism for assessing the degree to which a provider competently and safely delivers the appropriate clinical services to the patient within the optimal time period.”6 The AHA and American College of Cardiology Foundation have additionally suggested that performance measures should be based on the highest level of supportive evidence and have the greatest impact on health outcomes.7 Performance measures, in addition to supporting quality improvement activities, are specifically suitable for public reporting, external comparisons, and possibly pay-for-performance programs. As steward of the professional guidelines for stroke care, with a large group of volunteer expert clinicians with expertise in guideline creation and performance measurement, the AHA/ASA is uniquely positioned to develop high-quality …

Relationship between hospital performance measures and outcomes in patients with acute ischaemic stroke: a prospective cohort study

ObjectiveEvidence-based performance measures have been increasingly used to evaluate hospital quality of stroke care, but their impact on stroke outcomes has not been verified. We aimed to evaluate the correlations...

20 years of researching stroke through audit

Over the last 20 years, England, Wales and Northern Ireland have developed an audit programme that now encompasses nearly all patients admitted to hospital with a stroke. This article records and reviews some questions that have been answered using data from the audit: Is the rate of institutional care after rehabilitation a possible measure of outcome? Does stroke unit care in routine practice give the benefits shown in randomized controlled trials? How is the quality of stroke care affected by a patient’s age and the time of their stroke? Do patient-reported measures match those obtained from the professionals recording of processes of care? How do the processes of care after stroke affect mortality? Is thrombolysis safe to use in patients over the age of 80? Do staffing levels matter? Does assessing the safety of swallowing really make a difference? Do clinicians make rational decisions about end-of-life care in patients with haemorrhage? Does socioeconomic status influence the risk of stroke, outcome after stroke and the quality of stroke care? How much does stroke really cost in England, Wales and Northern Ireland? The article concludes that this national audit has improved stroke care across the United Kingdom, has given answers to important questions that could not be answered in any other way and has shown that benefits found in research do generalize into real clinical benefits in day-to-day practice.

Stroke Care in Sri Lanka: The Way We Were, the Way We Are, and the Way Forward

Sri Lanka is a lower-middle–income country with a high Human Development Index. Stroke is a primary cause of death and disability in the country, and demographic and epidemiological transitions are likely to lead to a large increase in the burden of stroke. Although impressive health indicators have been achieved due to an excellent primary health-care structure, Sri Lanka has been slow to develop and expand modern stroke care. A majority of the patients with acute strokes are treated in state-sector hospitals where facilities for state-of-the-art acute stroke care are limited. Neurologists are low in number, and general physicians provide acute stroke care for most of the patients. Epidemiological data on stroke in Sri Lanka are scarce. Previous studies have shown low quality of stroke care and significant gaps in stroke awareness. Noteworthy gains have been made since the turn of the century, and recent trends in development of stroke care are promising. There is a clear need to improve manpower, infrastructure, and training that will lead to improvements in the existing services in terms of acute care, rehabilitation, and community support. More research data are needed to guide strategies to minimize the burden of stroke, and more concerted efforts are needed to make stroke care in Sri Lanka ready to face the challenges of the 21st century.

Stroke Related Education To Emergency Department (ED) Staff - An Acute Stroke Care Quality Improvement Initiative (P5.255)

Stroke Related Education To Emergency Department (ED) Staff - An Acute Stroke Care Quality Improvement Initiative (P5.255)

The network of Shanghai Stroke Service System (4S): A public health-care web-based database using automatic extraction of electronic medical records.

Background Several stroke outcome and quality control projects have demonstrated the success in stroke care quality improvement through structured process. However, Chinese health-care systems are challenged with its overwhelming numbers of patients, limited resources, and large regional disparities. Aim To improve quality of stroke care to address regional disparities through process improvement. Method and design The Shanghai Stroke Service System (4S) is established as a regional network for stroke care quality improvement in the Shanghai metropolitan area. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Site-specific education and training program will be designed and administrated according to their baseline characteristics. Both acute reperfusion therapies including thrombectomy and thrombolysis in the acute phase and subsequent care were measured and monitored with feedback. Primary outcome is to evaluate the differences in quality metrics between baseline characteristics (including rate of thrombolysis in acute stroke and key performance indicators in secondary prevention) and post-intervention. Conclusions The 4S system is a regional stroke network that monitors the ongoing stroke care quality in Shanghai. This project will provide the opportunity to evaluate the spectrum of acute stroke care and design quality improvement processes for better stroke care. A regional stroke network model for quality improvement will be explored and might be expanded to other large cities in China. Clinical Trial Registration-URL http://www.clinicaltrials.gov . Unique identifier: NCT02735226.

Socioeconomic disparities in first stroke incidence, quality of care, and survival: a nationwide registry-based cohort study of 44 million adults in England

SummaryBackgroundWe aimed to estimate socioeconomic disparities in the incidence of hospitalisation for first-ever stroke, quality of care, and post-stroke survival for the adult population of England.MethodsIn this cohort study, we obtained data collected by a nationwide register on patients aged 18 years or older hospitalised for first-ever acute ischaemic stroke or primary intracerebral haemorrhage in England from July 1, 2013, to March 31, 2016. We classified socioeconomic status at the level of Lower Super Output Areas using the Index of Multiple Deprivation, a neighbourhood measure of deprivation. Multivariable models were fitted to estimate the incidence of hospitalisation for first stroke (negative binomial), quality of care using 12 quality metrics (multilevel logistic), and all-cause 1 year case fatality (Cox proportional hazards).FindingsOf the 43·8 million adults in England, 145 324 were admitted to hospital with their first-ever stroke: 126 640 (87%) with ischaemic stroke, 17 233 (12%) with intracerebral haemorrhage, and 1451 (1%) with undetermined stroke type. We observed a socioeconomic gradient in the incidence of hospitalisation for ischaemic stroke (adjusted incidence rate ratio 2·0, 95% CI 1·7–2·3 for the most vs least deprived deciles) and intracerebral haemorrhage (1·6, 1·3–1·9). Patients from the lowest socioeconomic groups had first stroke a median of 7 years earlier than those from the highest (p<0·0001), and had a higher prevalence of pre-stroke disability and diabetes. Patients from lower socioeconomic groups were less likely to receive five of 12 care processes but were more likely to receive early supported discharge (adjusted odds ratio 1·14, 95% CI 1·07–1·22). Low socioeconomic status was associated with a 26% higher adjusted risk of 1-year mortality (adjusted hazard ratio 1·26, 95% CI 1·20–1·33, for highest vs lowest deprivation decile), but this gradient was largely attenuated after adjustment for the presence of pre-stroke diabetes, hypertension, and atrial fibrillation (1·11, 1·05–1·17).InterpretationWide socioeconomic disparities exist in the burden of ischaemic stroke and intracerebral haemorrhage in England, most notably in stroke hospitalisation risk and case fatality and, to a lesser extent, in the quality of health care. Reducing these disparities requires interventions to improve the quality of acute stroke care and address disparities in cardiovascular risk factors present before stroke.FundingNHS England and the Welsh Government.

Quality of Care for Veterans With Transient Ischemic Attack and Minor Stroke

The timely delivery of guideline-concordant care may reduce the risk of recurrent vascular events for patients with transient ischemic attack (TIA) and minor stroke. Although many health care organizations measure stroke care quality, few evaluate performance for patients with TIA or minor stroke, and most include only a limited subset of guideline-recommended processes. To assess the quality of guideline-recommended TIA and minor stroke care across the Veterans Health Administration (VHA) system nationwide. This cohort study included 8201 patients with TIA or minor stroke cared for in any VHA emergency department (ED) or inpatient setting during federal fiscal year 2014 (October 1, 2013, through September 31, 2014). Patients with length of stay longer than 6 days, ventilator use, feeding tube use, coma, intensive care unit stay, inpatient rehabilitation stay before discharge, or receipt of thrombolysis were excluded. Outlier facilities for each process of care were identified by constructing 95% CIs around the facility pass rate and national pass rate sites when the 95% CIs did not overlap. Data analysis occurred from January 16, 2016, through June 30, 2017. Ten elements of care were assessed using validated electronic quality measures. In the 8201 patients included in the study (mean [SD] age, 68.8 [11.4] years; 7877 [96.0%] male; 4856 [59.2%] white), performance varied across elements of care: brain imaging by day 2 (6720/7563 [88.9%]; 95% CI, 88.2%-89.6%), antithrombotic use by day 2 (6265/7477 [83.8%]; 95% CI, 83.0%-84.6%), hemoglobin A1c measurement by discharge or within the preceding 120 days (2859/3464 [82.5%]; 95% CI, 81.2%-83.8%), anticoagulation for atrial fibrillation by day 7 after discharge (1003/1222 [82.1%]; 95% CI, 80.0%-84.2%), deep vein thrombosis prophylaxis by day 2 (3253/4346 [74.9%]; 95% CI, 73.6%-76.2%), hypertension control by day 90 after discharge (4292/5979 [71.8%]; 95% CI, 70.7%-72.9%), neurology consultation by day 1 (5521/7823 [70.6%]; 95% CI, 69.6%-71.6%), electrocardiography by day 2 or within 1 day prior (5073/7570 [67.0%]; 95% CI, 65.9%-68.1%), carotid artery imaging by day 2 or within 6 months prior (4923/7685 [64.1%]; 95% CI, 63.0%-65.2%), and moderate- to high-potency statin prescription by day 7 after discharge (3329/7054 [47.2%]; 95% CI, 46.0%-48.4%). Performance varied substantially across facilities (eg, neurology consultation had a facility outlier rate of 53.0%). Performance was higher for admitted patients than for patients cared for only in EDs with the greatest disparity for carotid artery imaging (4478/5927 [75.6%] vs 445/1758 [25.3%]; P < .001). This national study of VHA system quality of care for patients with TIA or minor stroke identified opportunities to improve care quality, particularly for patients who were discharged from the ED. Health care systems should engage in ongoing TIA care performance assessment to complement existing stroke performance measurement.

Absence of July Phenomenon in Acute Ischemic Stroke Care Quality and Outcomes

BackgroundLower care quality and an increase in adverse outcomes as a result of new medical trainees is a concept well rooted in popular belief, termed the “July phenomenon.” Whether this phenomenon occurs in acute ischemic stroke has not been well studied.Methods and ResultsWe analyzed data from patients admitted with ischemic stroke in 1625 hospitals participating in the Get With The Guidelines–Stroke program for the 5‐year period between January 2009 and December 2013. We compared acute stroke treatment processes and in‐hospitals outcomes among the 4 quarters (first quarter: July–September, last quarter: April–June) of the academic year. Multivariable logistic regression models were used to evaluate the relationship between academic year transition and processes measures. A total of 967 891 patients were included in the study. There was a statistically significant, but modest (<4 minutes or 5 percentage points) difference in distribution of or quality and clinical metrics including door‐to‐computerized tomography time, door‐to‐needle time, the proportion of patients with symptomatic intracranial hemorrhage within 36 hours of admission, and the proportion of patients who received defect‐free care in stroke performance measures among academic year quarters (P<0.0001). In multivariable analyses, there was no evidence that quarter 1 of the academic year was associated with lower quality of care or worse in‐hospital outcomes in teaching and nonteaching hospitals.ConclusionsWe found no evidence of the “July phenomenon” in patients with acute ischemic stroke among hospitals participating in the Get With The Guidelines–Stroke program.

Abstract TP231: Predicting Emergency Medical Services Use in a Rural State

Introduction: Hospital arrival by emergency medical services (EMS) is important for decreasing time from stroke onset to arrival and increasing the rate of rtPA use. In rural states, like Iowa, EMS is an often volunteer and dispersed resource which may influence the use of private vehicles. Objective: The objective of this study was to identify predictors of EMS use compared to private vehicle transport in Iowa stroke patients. Methods: A retrospective analysis was conducted using 2016 data collected by the Iowa Stroke Registry. The Iowa Stroke Registry is a statewide, concurrent database used to improve the Iowa Stroke System and quality of stroke care between EMS and hospitals in Iowa (1 comprehensive center, 15 primary centers, and 9 acute stroke hospitals). Inclusion was limited to arrival by EMS or private vehicles in the year 2016; all other arrivals were excluded. Predictors of EMS use were evaluated from admission, arrival, demographic, medical history, and hospital data. Chi square analyses and multivariate logistic regression were performed to determine associations and predictors of EMS use. Significance was at the 0.05 probability level. Results: The inclusion criteria was met by 2650 patients with 1335 (50.4%) arriving by EMS. A total of 1739 patient records were included in the analysis and 829 (47.7%) arrivals were from EMS compared to private vehicles. Results from the multivariate analysis indicated that EMS use was significantly associated with patients aged 65 or older, Native Americans, neurological symptoms of altered consciousness, aphasia, and weakness, history of atrial fibrillation, antidepressant medication use, hormone replacement therapy, and arrival in the northeast, south central, and southeast regions of the state. Private vehicle use was associated with resolved stroke symptoms at initial exam and the ability to ambulate independently prior to stroke. Patients arriving by EMS were more likely to arrive in the first 2 hours of symptom onset and receive rtPA compared to private vehicle arrivals. Conclusion: The proportion of arrivals by EMS and private vehicles were similar in 2016. Neurological symptoms of stroke, age, ambulatory status and region of the state were the most influential factors in determining EMS use.

Abstract TP222: Improving the Quality of Acute Stroke Care in regional Australia: The Victorian Stroke Telemedicine Program

Background: The Victorian Stroke Telemedicine (VST) program is the largest stroke telemedicine service operating in Australia. Patients and clinicians at 16 regional hospitals in Victoria are provided with 24/7/365 access to a network of on-call metropolitan-based neurologists via telemedicine. The VST program supports rapid differential diagnosis and enhances access to best-practice treatments for acute stroke, including transfer to comprehensive stroke centres for endovascular clot retrieval (ECR). Method: A historical-controlled cohort design was used to evaluate the VST Program. At each hospital, consecutive patient-level data were obtained 12 months before the VST program commenced (pre) and during the first 12 months of implementing the program (post). Basic clinical data were collected for patients aged 18 years or more and arriving in the Emergency Department (ED) with suspected stroke. Detailed data collection on the patient journey in hospital was conducted for patients with a confirmed ischemic stroke who arrived within 4.5 hours of symptom onset. Aggregated descriptive statistics using the available data for 16 hospitals are presented. Results: Overall, 6099 patients with suspected stroke (2932 pre, 3167 post) have presented up to 28/7/2017. Patients arriving to ED within 4.5 hours of ischemic stroke symptom onset: pre-VST n=358 (54% male; mean age 74 years) and post-VST n=484 (59% male, median age 76 years). The proportion of patients meeting these criteria who received intravenous thrombolysis increased (pre: 30% to post: 38%, p=0.019). The median door-to-needle time was faster (pre: 103 minutes; post: 72 minutes, p&lt;0.001), and more patients received thrombolysis within 60 minutes of arrival (pre: 14%; post: 32%, p&lt;0.001). Symptomatic intracerebral hemorrhage after thrombolysis was reduced (pre: 16%; post: 5%, p=0.002). Since the availability of ECR in May 2015, 25% of cases receiving thrombolysis were transferred for ECR. Conclusion: Telemedicine expedites access to optimal stroke care and immediately facilitated access to the newest intervention, ECR, with more patients safely and efficiently treated.

Centralisation of acute stroke services in London: Impact evaluation using two treatment groups.

The bundling of clinical expertise in centralised treatment centres is considered an effective intervention to improve quality and efficiency of acute stroke care. In 2010, 8 London Trusts were converted into Hyper Acute Stroke Units. The intention was to discontinue acute stroke services in 22 London hospitals. However, in reality, provision of services declined only gradually, and 2years later, 15% of all patients were still treated in Trusts without a Hyper Acute Stroke Unit. This study evaluates the impact of centralising London's stroke care on 7 process and outcome indicators using a difference-in-difference analysis with two treatment groups, Hyper Acute and discontinued London Trusts, and data on all stroke patients recorded in the hospital episode statistics database from April 2006 to April 2014. The policy resulted in improved thrombolysis treatment and lower rates of pneumonia in acute units. However, 6 indicators worsened in the Trusts that were meant to discontinue services, including deaths within 7 and 30days, readmissions, brain scan rates, and thrombolysis treatment. The reasons for these results are difficult to uncover and could be related to differences in patient complexity, data recording, or quality of care. The findings highlight that actual implementation of centralisation policies needs careful monitoring and evaluation.

Prognosis of Midlife Stroke

To characterize stroke outcomes in a midlife population-based stroke cohort, and to describe comorbidities, quality of care, and risk of recurrence in this age group. Ischemic strokes (ISs) were identified from the population-based Brain Attack Surveillance in Corpus Christi Project (2000-2012). Data were from medical records and patient interviews. Ninety-day outcomes (functional, neurologic, cognitive, quality of life [QOL]), prevalence of comorbidities, quality of care, and 1-year recurrence were estimated for those aged 45-64 (midlife) and compared with those aged ≥65 using sex and race-ethnicity adjusted regression models. Of 4858 ISs, 33% occurred in midlife. On average, the midlife group reported some difficulty with function, favorable neurologic and cognitive outcomes, and moderate QOL scores at 90 days. All outcomes except QOL were better in the midlife group. Prevalent comorbidities in midlife were hypertension (74%), diabetes (51%), hyperlipidemia (34%), heart disease (26%), prior stroke/transient ischemic attack (23%), smoking 37%, excess alcohol 10%, and atrial fibrillation 4%. Median body mass index (BMI) was 30 (interquartile range: 26-35). Diabetes, smoking, and alcohol were more prevalent and BMI higher in the midlife group. Quality of stroke care did not differ by age. One-year recurrence in midlife was 8% (95% confidence interval: 6%-9%) and did not differ by age. While 90-day outcomes were more favorable than in the elderly, midlife stroke survivors faced some disability and did not experience better QOL despite better outcomes. Additional research should identify targets to optimize secondary stroke prevention and improve outcomes in midlife stroke survivors-an understudied group with great potential disability and economic impact.

Emergency Overcrowding Impact on the Quality of Care of Patients Presenting with Acute Stroke.

Introduction:Emergency overcrowding is defined as when the amount of care required for patients overcomes the available amount. This can cause delays in delivering critical care in situations like stroke. Objective:The aim of this study was to assess the possible impact of emergency department (ED) crowding on the quality of care for acute stroke patients. Methods:In this cross-sectional prospective study, all patients with symptoms of acute stroke presenting to the ED of educational hospitals were enrolled. All patients were assessed and examined by the emergency medicine (EM) residents on shift and a questionnaire was filled out for them. The amount of time that passed from the first triage to performing the required interventions and delivering health services were recorded by the triage nurse. ED crowding was measured by the occupancy rate. Then, the correlation between all of the variables and ED crowding level were calculated. Results:The average daily bed occupancy rate was 184.9 ± 54.3%. The median time passed from the first triage to performing the interventions were as follows: the first EM resident visit after 34 min, the first neurologic visit after 138 min, head CT after 134 min, ECG after 104 min and ASA administration after 210 min. There was no statistically significant relationship between the ED occupancy rate and the time elapsed before different required health services in the management of stroke patients either throughout an entire day or during each 8-hour interval (p > 0.05). Conclusion:In the current study, the ED occupancy rate was not significantly correlated with the time frame associated with management of admitted acute stroke patients.

Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model.

BackgroundStroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine.ObjectiveWe aim to develop a first cost effectiveness model for in-ambulance telemedicine and use this model to estimate the time savings needed before in-ambulance telemedicine becomes cost effective.MethodsCurrent standard stroke care is compared with current standard stroke care supplemented with in-ambulance telemedicine using a cost-utility model measuring costs and quality-adjusted life-years (QALYs) from a health care perspective. We combine a decision tree with a Markov model. Data from the UZ Brussel Stroke Registry (2282 stroke patients) and linked hospital claims data at individual level are combined with literature data to populate the model. A 2-way sensitivity analysis varying both implementation costs and time gain is performed to map the different cost-effective combinations and identify the time gain needed for cost effectiveness and dominance. For several modeled time gains, the cost-effectiveness acceptability curve is calculated and mapped in 1 figure.ResultsUnder the base-case scenario (implementation cost of US $159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US –$30 (95% CI –$32 to –$29) per patient with 0.00456 (95% CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82% of all probabilistic simulations, in-ambulance telemedicine remains under the cost-effectiveness threshold of US $47,747.ConclusionsOur model suggests that in-ambulance telemedicine can be cost effective starting from a time gain of 6 minutes and becomes a dominant strategy after approximately 15 minutes. This indicates that in-ambulance telemedicine has the potential to become a cost-effective intervention assuming time gains in clinical implementations are realized in the future.

Resultados en el tratamiento del ictus en hospitales con y sin Unidad de Ictus

IntroductionOrganisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. MethodsWe conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients’ evaluations of the service and healthcare received. ResultsCentres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. ConclusionCentres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department.

Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis.

Translating research evidence into clinical practice often uses key performance indicators to monitor quality of care. We conducted a systematic review to identify the stroke key performance indicators used in large registries, and to estimate their association with patient outcomes. We sought publications of recent (January 2000-May 2017) national or regional stroke registers reporting the association of key performance indicators with patient outcome (adjusting for age and stroke severity). We searched Ovid Medline, EMBASE and PubMed and screened references from bibliographies. We used an inverse variance random effects meta-analysis to estimate associations (odds ratio; 95% confidence interval) with death or poor outcome (death or disability) at the end of follow-up. We identified 30 eligible studies (324,409 patients). The commonest key performance indicators were swallowing/nutritional assessment, stroke unit admission, antiplatelet use for ischaemic stroke, brain imaging and anticoagulant use for ischaemic stroke with atrial fibrillation, lipid management, deep vein thrombosis prophylaxis and early physiotherapy/mobilisation. Lower case fatality was associated with stroke unit admission (odds ratio 0.79; 0.72-0.87), swallow/nutritional assessment (odds ratio 0.78; 0.66-0.92) and antiplatelet use for ischaemic stroke (odds ratio 0.61; 0.50-0.74) or anticoagulant use for ischaemic stroke with atrial fibrillation (odds ratio 0.51; 0.43-0.64), lipid management (odds ratio 0.52; 0.38-0.71) and early physiotherapy or mobilisation (odds ratio 0.78; 0.67-0.91). Reduced poor outcome was associated with adherence to swallowing/nutritional assessment (odds ratio 0.58; 0.43-0.78) and stroke unit admission (odds ratio 0.83; 0.77-0.89). Adherence with several key performance indicators appeared to have an additive benefit. Adherence with common key performance indicators was consistently associated with a lower risk of death or disability after stroke. Policy makers and health care professionals should implement and monitor those key performance indicators supported by good evidence.

The registry of stroke care quality (RES-Q): The first nation-wide data on stroke care quality

Background: Effective stroke treatment exists, but the implementation of evidence-based practices is limited. Therefore, we developed and deployed the Registry of Stroke Care Quality (RES-Q) in 20 European countries.

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English.

BackgroundThe inability to communicate effectively in a common language can jeopardize clinicians’ efforts to provide quality patient care. Professional medical interpreters (PMIs) can help provide linguistically appropriate health care, in particular for the >25 million Americans who identify speaking English less than very well. We aimed to evaluate the relationship between use of PMIs and quality of acute ischemic stroke care received by patients who preferred to have their medical care in languages other than English.Methods and ResultsWe analyzed data from 259 non–English‐preferring acute ischemic stroke patients who participated in the American Heart Association Get With The Guidelines–Stroke program at our hospital from January 1, 2003, to April 30, 2014. We used descriptive statistics and logistic regression models to examine associations between involvement of PMIs and patients’ receipt of defect‐free stroke care. A total of 147 of 259 (57%) non–English‐preferring patients received PMI services during their hospital stays. Multivariable analyses adjusting for other socioeconomic factors showed that acute ischemic stroke patients who did not receive PMIs had lower odds of receiving defect‐free stroke care (odds ratio: 0.52; P=0.04).ConclusionsOur findings suggest that PMIs may influence the quality of acute ischemic stroke care.

Improving quality and outcomes of stroke care in hospitals: Protocol and statistical analysis plan for the Stroke123 implementation study.

change in individual indicators, change in composite score comparing hospitals that did or did not develop action plans (per-protocol analysis), impact on 90-180-day health outcomes. Sensitivity analyses: hospital self-rated status, alternate cross-sectional audit data (Stroke Foundation). To account for temporal effects, comparison of Queensland hospital performance relative to other Australian hospitals will also be undertaken. Discussion Twenty-one hospitals were recruited; however, one was unable to participate within the study time frame. Workshops were held between 11 March 2014 and 7 November 2014. Data are ready for analysis.