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Review
. 2017 Dec;2(4):287-307.
doi: 10.1177/2396987317735426. Epub 2017 Oct 5.

Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis

Gerard Urimubenshi  1   2 , Peter Langhorne  1 , Dominique A Cadilhac  3   4 , Jeanne N Kagwiza  2 , Olivia Wu  5
Affiliations
Review

Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis

Gerard Urimubenshi et al. Eur Stroke J. 2017 Dec.

Abstract

Purpose: Translating research evidence into clinical practice often uses key performance indicators to monitor quality of care. We conducted a systematic review to identify the stroke key performance indicators used in large registries, and to estimate their association with patient outcomes.

Method: We sought publications of recent (January 2000-May 2017) national or regional stroke registers reporting the association of key performance indicators with patient outcome (adjusting for age and stroke severity). We searched Ovid Medline, EMBASE and PubMed and screened references from bibliographies. We used an inverse variance random effects meta-analysis to estimate associations (odds ratio; 95% confidence interval) with death or poor outcome (death or disability) at the end of follow-up.

Findings: We identified 30 eligible studies (324,409 patients). The commonest key performance indicators were swallowing/nutritional assessment, stroke unit admission, antiplatelet use for ischaemic stroke, brain imaging and anticoagulant use for ischaemic stroke with atrial fibrillation, lipid management, deep vein thrombosis prophylaxis and early physiotherapy/mobilisation. Lower case fatality was associated with stroke unit admission (odds ratio 0.79; 0.72-0.87), swallow/nutritional assessment (odds ratio 0.78; 0.66-0.92) and antiplatelet use for ischaemic stroke (odds ratio 0.61; 0.50-0.74) or anticoagulant use for ischaemic stroke with atrial fibrillation (odds ratio 0.51; 0.43-0.64), lipid management (odds ratio 0.52; 0.38-0.71) and early physiotherapy or mobilisation (odds ratio 0.78; 0.67-0.91). Reduced poor outcome was associated with adherence to swallowing/nutritional assessment (odds ratio 0.58; 0.43-0.78) and stroke unit admission (odds ratio 0.83; 0.77-0.89). Adherence with several key performance indicators appeared to have an additive benefit.

Discussion: Adherence with common key performance indicators was consistently associated with a lower risk of death or disability after stroke.

Conclusion: Policy makers and health care professionals should implement and monitor those key performance indicators supported by good evidence.

Keywords: Stroke; care quality; indicator; patient outcome.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Review profile showing selection of studies. HR: hazard ratio; KPI: key performance indicator; OR: odds ratio.
Figure 2.
Figure 2.
Association between individual KPIs and lower risk for case fatality. AF: atrial fibrillation; CT: computerised tomography; MRI: magnetic resonance imaging; CI: confidence interval; DVT: deep vein thrombosis; I2: heterogeneity; IS: ischaemic stroke; IV: inverse variance; KPI: key performance indicator; N: number of.
Figure 3.
Figure 3.
Association between individual KPIs and lower risk for poor outcome. ADLs: activities of daily living; CT: computerised tomography; MRI: magnetic resonance imaging; CI: confidence interval; DVT: deep vein thrombosis; I2: heterogeneity; IS: ischaemic stroke; IV: inverse variance; KPI: key performance indicator; N: number of.
See this image and copyright information in PMC

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