Clinical indicators for acute stroke in Japan: for spread of the advanced stroke management and care strategy

Abstract

Stroke is a major leading cause of disability in Japan. In order to improve stroke outcome, national and international quality initiatives should be indispensable. We developed evidence-based clinical indicators including 13 items for acute stroke care. In this study, we investigated the actual conditions of acute stroke care by use of the clinical indicators. We enrolled 1686 stroke patients in 44 hospitals with diagnoses of brain infarction, intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack admitted within 3 days after the onset from July 2010 to September 2010. All hospitals were divided into bipartite by the number of population density and tertile by the number of registered patients, hospital beds, and physicians in charge of stroke. We compared states of achievement of clinical indicators. The states of achievement of brain CT/MRI, evaluation of cerebral arteries by carotid ultrasonography, MR angiography or CT angiography, prescription of antithrombotic agents, and measurements of blood sugar and lipid profiles were over 90%. The state of achievement of physical therapy was highest in the group of hospitals which registered a large number of patients (p=0.026) and the percentage of patients prescribed antithrombotic agents was highest in the group of hospitals which registered a small number of patients (p=0.0046). There was no relationship between states of achievement of clinical indicators and number of population density, hospital beds and physicians in charge of stroke, respectively. We showed the present conditions of acute stroke care in Japan by use of the clinical indicators. The next step is to organize a nationwide monitoring using clinical indicators.