Benchmarks for acute stroke care delivery

Abstract

ObjectiveDespite widespread interest in many jurisdictions in monitoring and improving the quality of stroke care delivery, benchmarks for most stroke performance indicators have not been established. The objective of this study was to develop data-derived benchmarks for acute stroke quality indicators.DesignNine key acute stroke quality indicators were selected from the Canadian Stroke Best Practice Performance Measures Manual.ParticipantsA population-based retrospective sample of patients discharged from 142 hospitals in Ontario, Canada, between 1 April 2008 and 31 March 2009 (N = 3191) was used to calculate hospital rates of performance and benchmarks.InterventionThe Achievable Benchmark of Care (ABC™) methodology was used to create benchmarks based on the performance of the upper 15% of patients in the top-performing hospitals.Main Outcome MeasuresBenchmarks were calculated for rates of neuroimaging, carotid imaging, stroke unit admission, dysphasia screening and administration of stroke-related medications.ResultsThe following benchmarks were derived: neuroimaging within 24 h, 98%; admission to a stroke unit, 77%; thrombolysis among patients arriving within 2.5 h, 59%; carotid imaging, 93%; dysphagia screening, 88%; antithrombotic therapy, 98%; anticoagulation for atrial fibrillation, 94%; antihypertensive therapy, 92% and lipid-lowering therapy, 77%. ABC™ acute stroke care benchmarks achieve or exceed the consensus-based targets required by Accreditation Canada, with the exception of dysphagia screening.ConclusionsBenchmarks for nine hospital-based acute stroke care quality indicators have been established. These can be used in the development of standards for quality improvement initiatives.

How Reliable Are Administrative Data for Capturing Stroke Patients and Their Care

“…Description of the audit sampling strategy and a complete breakdown of exclusions is reported elsewhere [14]. …”

The characteristics of stroke units in Ontario: a pan-provincial survey

“… HNHB Hamilton Niagara Haldimand Brant, LHIN Local Health Integration Network, N/A Not Applicable, SU Stroke Unit, TIA Transient Ischemic Attack a Data source: Ontario Stroke Evaluation Report 2014 [17]…”

“…In the current study, all 32 identified SUs had a geographically defined location, and the majority were based in a general medicine ward with a median of 13 beds. At the time of the survey, Canadian recommendations did not require SUs to be exclusive to stroke patients, nor have all of the resources in place; however, recommendations did require SUs to be in one geographic location [17]. Later in 2014, the OSN revised the definition of SUs, which included additional criteria related to bed allocation and staff.…”

“…Later in 2014, the OSN revised the definition of SUs, which included additional criteria related to bed allocation and staff. According to the new definition “a stroke unit is a geographical unit with identifiable co-located beds that are occupied by stroke patients 75% of the time and have a dedicated interprofessional team with expertise in stroke care including, at a minimum, nursing, physiotherapy, occupational therapy and speech-language pathology” [17]. Though our questionnaire did not specifically ask for the number of beds occupied exclusively by stroke patients, we can speculate that the ASUs with no dedicated beds for stroke patients (half of ASUs) might fail to meet that criterion.…”

“…We used boundaries of each LHIN to estimate geographic distribution of SUs [16]. The number of available SUs and stroke incident cases per LHIN (2012-2013) were used to approximate potential volume of stroke patients treated per SU [17]. …”