Improving quality in stroke rehabilitation.

Given the numerous quality improvement (QI) initiatives that have been undertaken in various medical fields, it is clear that inpatient rehabilitation services, particularly those geared toward stroke rehabilitation, can also benefit from these programs. To effectively evaluate the quality of rehabilitation services, indicators measuring structure, process, and outcomes must be included as part of any QI initiative. In addition to measuring quality, these indicators can be used to describe and address disparities in the provision of rehabilitation services on the basis of race, socioeconomic status, geography, disability status, and a multitude of other demographic factors. To improve quality and address health disparities associated with stroke rehabilitation, QI initiatives must be scientifically driven, continuing the trend of evidence-based practice in medicine. They must also remain flexible, because the science of quality improvement is an ever-changing field. It will be a challenge to convince physicians and other health care professionals that QI initiatives are a worthwhile investment of their limited time and resources, and further research is required to move the field of quality in stroke rehabilitation forward.