Variations in Quality Indicators of Acute Stroke Care in 6 European Countries

Abstract

Background and Purpose-Quality indicators serve as standards of care by which performance of individual hospitals is measured. Although several audits for monitoring quality of stroke care have been established in Europe, there is currently no consensus on quality indicators for acute stroke care or for methodology for collecting information on these measures. Methods-An up-to-date inventory on European stroke audits in place in 2006 was performed in the course of a project funded by the European Union (European Implementation Score Collaboration [EIS]). Two regional (Flanders, Belgium; Catalonia, Spain) and 4 national (Germany, Scotland, Sweden, England/Wales/Northern Ireland) stroke audits took part. Between November 2009 and July 2010, 2 standardized surveys and a series of interviews were performed to determine characteristics, methods, and content of these quality initiatives. For quality purposes, all summarized information was validated by representatives of the respective audits. Results-Overall, 123 quality indicators (91 process, 24 outcome, and 8 structural indicators) were identified.Anticoagulants in patients with atrial fibrillation and brain imaging were the only quality indicators used in all, whereas another 13 indicators were used in at least 2 of the quality initiatives. Substantial variations were found across the audits in terms of the development process of quality indicators, inclusion criteria, participation, population coverage, data documentation, follow-ups, benchmarking, and feedback of results to participants. Conclusions-There is a huge variety in measuring performance of acute stroke care in Europe, hampering valid comparisons of acute stroke care.

Approaches for optimizing medical aid in acute ischemic stroke patients, hospitalized in UMHAT „Saint Marina` - Varna

“…Quality indicators for the management of AIS patients with and without TL at our center were compared with the results from six European countries -Belgium, England Germany, Sweden, Spain, Scotland, published by the European Implementation Score Collaborative, presented in table 2 (17).…”

“…❖ Based on the analysis of the data from the papers and the five-year research, we offer the introduction of Quality Indicators on a national Bulgarian level, related to the optimization of acute stroke management as follows: (17).…”

“…It is necessary to introduce effective measures for implementation of the activities not only in the hospital but in the region as well (17).…”

Methods of Implementation of Evidence-Based Stroke Care in Europe

“…Whether more effective implementation translates in better stroke services and outcomes is challenging, also because of difficulties arising when comparing quality measures across countries. 9 England, Scotland, and Sweden showed high levels of implementation. They all have long-lasting national programs monitoring stroke care: the Sentinel Stroke National Audit Program, 13 the Scottish Stroke Care Audit, 14 and the Swedish Stroke Register (Riks-Stroke).…”

“…8 This provided the conceptual framework to develop a questionnaire designed to evaluate methods used to translate research findings into practice in 10 European countries, in which either audits or population-based stroke registers agreed to participate in the EIS project: Belgium, England, France, Germany, Italy, Lithuania, Poland, Scotland, Spain, and Sweden. 9 The questionnaire was developed after a series of meetings, audio conferences, and e-mail contacts among the work package board and other EIS collaborators. Adopting Goffman framing analysis models, as revised by Pope et al, 10 which consider modern health care as a complex, multilevel system, with multiple interacting actors and layers, implementation strategies were investigated at 3 levels, such as macro (eg, national and regional policies), meso (organizational, eg, audits and guidelines), and micro (eg, patients and professionals), and in the different settings (primary, hospital, and specialist) of stroke care.…”