Kirsten Haas1, Viktoria Rücker1, Peter Hermanek2, Björn Misselwitz3, Klaus Berger4, Günter Seidel5, Alfred Janssen6, Susanne Rode7, Christoph Burmeister8, Christine Matthis9, Hans-Christian Koennecke10, Peter U Heuschmann1,11. 1. Institute of Clinical Epidemiology and Biometry, University of Würzburg (K.H., V.R., P.U.H.). 2. Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich (P.H.). 3. Institute of Quality Assurance Hesse (GQH) (B.M.). 4. Quality Assurance Project "Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster (K.B.). 5. Department of Neurology, Asklepios Klinik Nord, Hamburg (G.S.). 6. Quality Assurance in Stroke Management in North Rhine-Westphalia, Medical Association North Rhine (A.J.). 7. Office for Quality Assurance in Health Care Baden-Württemberg GmbH (QiG BW GmbH), Stuttgart (S.R.). 8. Institute of Quality Assurance Rhineland-Palatinate/SQMed (C.B.). 9. Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck (C.M.). 10. Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin (H.-C.K.). 11. Clinical Trial Center, University Hospital Würzburg (P.U.H.).
Abstract
BACKGROUND AND PURPOSE: Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals. METHODS: Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital. RESULTS: Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%-100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8-13.7]; P<0.001). CONCLUSIONS: Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.
BACKGROUND AND PURPOSE: Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals. METHODS:Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital. RESULTS: Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%-100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8-13.7]; P<0.001). CONCLUSIONS: Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.
Authors: Max Geraedts; Dijana Ebbeler; Nina Timmesfeld; Manfred Kaps; Klaus Berger; Björn Misselwitz; Christian Günster; Patrik Dröge; Michael Schneider Journal: Dtsch Arztebl Int Date: 2021-12-17 Impact factor: 5.594