Stroke units and general wards in seven Italian regions: the PROSIT Study

Candelise, Livia; Micieli, Giuseppe; Sterzi, Roberto; Morabito, Alberto

doi:10.1007/s10072-005-0440-7

Cited by 14 publications

(12 citation statements)

References 9 publications

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“…All SUs reported that they have multidisciplinary meetings and practice early rehabilitation. These findings, compared with our previous survey [13,14], show the tendency in Italy to increase the number and the quality of structures dedicated to stroke care. Nevertheless, the study demonstrated an overall shortage of stroke unit beds, which was clearer in the central and southern parts of the country.…”

Section: Discussionsupporting

confidence: 52%

“…A shortage of acute SU beds is also evident in many European countries where the percent of stroke patients hospitalised in a SU bed ranged from 5% to 40%. Access to SUs is quite good in Norway [18], Sweden [19], Germany [20], Austria [21] and Scotland [22], but is still patchy in France [23], Hungary [24], Italy [13,14], Poland [25] and Portugal [26]. In Australia only 23% of hospitals had a SU [27].…”

Section: Discussionmentioning

confidence: 99%

“…For the present study conducted on all 21 national regions we used the same standard methodology of the previous survey on seven regions [13,14]. A list of all patients hospitalised during 2001 for acute stroke (DRG 14) together with the code of the hospital ward where they were admitted was obtained from the national Minister of Health facilities.…”

Section: Data Sourcementioning

confidence: 99%

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Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

et al. 2006

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and the availability of rapid diagnostic investigations (ROC area=0.7164) had lower power in discriminating SU from GW. In Italy in 2003/04 only 9% of the hospital services had organised SU care. The study demonstrated that SUs admitted more than 100 patients per year, had more monitoring equipment and staffing time, and practised multidisciplinary meetings and early mobilisation. The utility of these structural and performance characteristics needs validation from outcome studies. [3]. Many stroke physicians claim that these delays in SU implementation are due to a shortage of adequate resources. But the general uncertainty about the best SU model is also a contributor to this delay. In fact, despite the meta-analysis providing evidence in favour of the comprehensive SU model, SUs currently implemented vary significantly in structure and organisation [4][5][6][7]. Randomised clinical trials and other research have been used to evaluate the efficacy of the individual elements of care that would improve stroke patient outcomes [4,[8][9][10][11][12]. But clear evidence of the relative efficacy for different models combining different structural and performance characteristics is very poor [10]. New SU research is still necessary to identify well defined and measurable quality indicators, evaluating both structural and performance parameters, for outcome studies. Abstract The future challenge for improving stroke patients' outcome will be to implement new Stroke Units (SUs) worldwide. However the best SU model remains uncertain. The aim of this study was to evaluate the number of SUs and the quality characteristics of acute stroke care in Italy. We conducted a SU survey in Italy, interviewing the directors of the hospital wards that discharged at least 50 acute stroke patients a year. A SU was defined as an acute ward area with stroke-dedicated beds and staff. Key wordsTo compare the quality of care provided in SUs with that in general wards (GWs) we investigated the characteristics of five domains: hospital setting, unit setting, staffing, process of care and diagnostic investigations. We identified 68 SUs and 677 GWs. Multivariate logistic regression analyses demonstrated that SUs compared to GWs had higher quality scores in unit setting (ROC area=0.9721), staffing (ROC area=0.8760) and care organisation (ROC area=0.7984). The hospital setting (ROC area=0.7033)

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Data Sourcementioning

confidence: 99%

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Stroke Unit care in Italy. Results from PROSIT (Project on Stroke Services in Italy). A nationwide study

et al. 2006

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“…The factors influencing quality service provision are likely to be different in each. The availability of the most effective intervention (coordinated stroke unit care 18 ) remains limited, reflecting results from recent large-scale national 19,20 and international 5,21 studies.…”

Section: Discussionmentioning

confidence: 99%

Developing a Tool to Assess Quality of Stroke Care Across European Populations

Wellwood

Langhorne

et al. 2011

Stroke

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on behalf of the European Registers of Stroke (EROS) Collaborative GroupBackground and Purpose-There are significant differences in the provision of care and outcome after stroke across countries. The European Registers of Stroke study aimed to develop, test, and refine a tool to assess quality of care. Methods-We used a systematic review and grading of evidence for stroke care across the clinical pathway and developed and field-tested a quality tool that was delivered by post and later by site visit at 7 centers. Items were refined by using an algorithm that took into account the level of evidence, measurement properties, and consensus of opinion obtained using, the Delphi techniques. Results-The tool included 251 items across 11 domains, of which 214 items could be categorized by any level of evidence. Overall agreement between postal and site visit modes of delivery was acceptable (ϭ0.77), with most items having a Ͼ0.5. The refinement process resulted in 2 practical versions of the tool (93 items and 22 items). Positive responses to items in the tool indicated implementation of evidence-based stroke care. In field testing, the proportion of positive responses to evidence-based items ranged from 43% to 79% across populations. Proportions of different types of evidence being implemented were similar: high quality 62%, limited quality 72%, and expert opinion 54% across the populations. More than half (4 of 7) of the centers provided stroke unit care and thrombolysis, but availability and access to inpatient rehabilitation varied significantly, with poor access to community follow-up for rehabilitation and medical management. Key Words: stroke units Ⅲ stroke registers Ⅲ stroke management Ⅲ scales Ⅲ organized stroke care Ⅲ quality assessment Ⅲ performance measurement E uropean studies have shown that stroke service provision and outcomes vary considerably across Europe. 1-4 Grieve and colleagues 3 demonstrated in the late 1990s that there were significant variations in the costs of stroke care across Europe, with centers spending more per case generally having better outcomes, where the resource was deployed into stroke unit care. A more recent survey of European hospitals estimated that Ͻ10% that admitted acute stroke patients had optimal facilities, and in 40%, even the minimum level of facilities was unavailable. 5 Increasingly, assessment of the performance of health services is required if health costs are to be contained. In many countries, national and European guidelines have been endorsed, yet the quality of, and methods used to develop these guidelines vary. 6 -8 To assess quality and implementation of evidence in clinical practice, in the early 2000s in the United States, a national multidisciplinary panel assisted in the development of 44 potential stroke performance measures and identified 21 that rated highly for acute care. 9 More recently in the United States, performance measures have been developed for stroke and are being implemented by stroke quality improvement programs, although these measur...

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“…13,14 Limitations in procedural accessibility and nursing care availability further prohibit more complicated methods to reduce fever, highlighting the need for a safe, simple and cost-effective cooling strategy for stroke patients, particularly those non-critically ill admitted to the regular ward. [15][16][17] Based on clinical observations and theoretical cooling analyses, [18][19][20] we were interested in whether intravenous (IV) infusions of chilled crystalloid or designer ice slurry/ saline solutions, adjusted for safety and efficiency to daily fluid requirements and temperature fluctuations, would conveniently and inexpensively control fever. Intravenous fluids are routinely administered to patients with cerebrovascular events to stabilize intravascular volume and improve systemic cardiovascular function and brain perfusion.…”

Section: Introductionmentioning

confidence: 99%