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. 2014 Nov 7;111(45):759-65.
doi: 10.3238/arztebl.2014.0759.

The quality of acute stroke care- an analysis of evidence-based indicators in 260 000 patients

Silke Wiedmann  1 , Peter U Heuschmann, Steffi Hillmann, Otto Busse, Horst Wiethölter, Georg M Walter, Günter Seidel, Björn Misselwitz, Alfred Janssen, Klaus Berger, Christoph Burmeister, Christine Matthis, Peter Kolominsky-Rabas, Peter Hermaneks; German Stroke Registers Study Group (ADSR)
Collaborators, Affiliations

The quality of acute stroke care- an analysis of evidence-based indicators in 260 000 patients

Silke Wiedmann et al. Dtsch Arztebl Int. .

Abstract

Background: Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date.

Methods: The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects.

Results: Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6%). Dysphagia screening was documented in 86.2% (range, 74.8-93.1%). For the following indicators, the defined targets were not reached for all of Germany: anti-aggregation within 48 hours, 93.4% (range, 86.6-96.4%); anticoagulation for atrial fibrillation, 77.6% (range, 72.4-80.1%); standardized dysphagia screening, 86.2% (range, 74.8-93.1%); oral and written information of the patients or their relatives, 86.1% (range, 75.4-91.5%). The rate of patients examined or treated by a speech therapist was in the target range.

Conclusion: The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.

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Figures

eFigure
eFigure
Exemplary illustration of the quality indicators (QI) in registers‘ reports using the example of QI early thrombolysis in Bavaria in 2011 on the basis of a funnel plot (www.baq-bayern.de). QI, quality indicator; ADSR: German Stroke Registers Study Group; NIHSS, National Institutes of Health Stroke Scale
See this image and copyright information in PMC

Comment in

  • Analysis for gender differences needed.
    Rásky É, Groth S. Rásky É, et al. Dtsch Arztebl Int. 2015 Apr 17;112(16):288. doi: 10.3238/arztebl.2015.0288a. Dtsch Arztebl Int. 2015. PMID: 25939320 Free PMC article. No abstract available.
  • In reply.
    Wiedmann S, Heuschmann PU, Hermanek P. Wiedmann S, et al. Dtsch Arztebl Int. 2015 Apr 17;112(16):288. doi: 10.3238/arztebl.2015.0288b. Dtsch Arztebl Int. 2015. PMID: 25939321 Free PMC article. No abstract available.

References

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    1. Deutsche Gesellschaft für Neurologie. AWMF-Leitlinie 030 - 046, Akuttherapie des ischämischen Schlaganfalls. www.awmf.org/uploads/tx_szleitlinien/030-046l_S1_Akuttherapie_des_ischmi.... (last accessed on 1. August 2014)
    1. Heuschmann PU, Kolominsky Rabas PL, Kugler C, et al. Qualitätssicherung in der Schlaganfall-Behandlung: das Basismodul der Arbeitsgemeinschaft Deutscher Schlaganfall-Register (ADSR) Gesundheitswesen. 2000;62:547–552. - PubMed
    1. Heuschmann PU, Biegler MK, Busse O, et al. Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR) Stroke. 2006;37:2573–2578. - PubMed

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