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. 2023 Jan;8(1 Suppl):35-43.
doi: 10.1177/23969873221110745. Epub 2022 Jul 5.

Developments in quality of stroke care in Estonia

Janika Kõrv  1 , Katrin Antsov  2 , Katrin Gross-Paju  3 , Inga Kalju  4 , Andrus Kreis  5 , Aive Liigant  1   6 , Riina Vibo  1
Affiliations

Developments in quality of stroke care in Estonia

Janika Kõrv et al. Eur Stroke J. 2023 Jan.

Abstract

Background: Monitoring and measuring different aspects of stroke care pathway is the cornerstone for improvement of quality. We aim to analyze and give an overview of improvements of stroke care quality in Estonia.

Patients and methods: National stroke care quality indicators are collected and reported using reimbursement data and include all adult stroke cases. In Estonia, five stroke-ready hospitals are participating in Registry of Stroke Care Quality (RES-Q), providing data on all stroke patients 1 month every year. Data from the national quality indicators and RES-Q from 2015 to 2021 are presented.

Results: The proportion of intravenous thrombolysis for all Estonian hospitalized ischemic stroke cases increased from 16% (95% Confidence Interval, CI 15%-18%) in 2015 to 28% (95% CI 27%-30%) in 2021. Mechanical thrombectomy was provided to 9% (95% CI 8%-10%) in 2021. The 30-day mortality rate has decreased from 21% (95% CI 20%-23%) to 19% (95% CI 18%-20%). More than 90% of patients with cardioembolic stroke are prescribed anticoagulants at discharge, but only 50% are on anticoagulant treatment 1 year after stroke. Also, the availability of inpatient rehabilitation needs improvement, being 21% (95% CI 20%-23%) in 2021. A total of 848 patients are included in the RES-Q. The proportion of patients receiving recanalization therapies was comparable to the national stroke care quality indicators. All stroke-ready hospitals show good onset-to-door times.

Conclusion: The overall stroke care quality in Estonia is good, especially the availability of recanalization treatments. However, secondary prevention and the availability of rehabilitation services need improvement in the future.

Keywords: Estonia; Stroke; quality; registry.

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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.
Time trends of stroke quality indicators according to the Estonian Health Insurance Fund reimbursement database.
Figure 2.
Figure 2.
Proportion of patients with ischemic stroke receiving recanalization therapies in stroke-ready hospitals in Estonia from 2017 to 2021 according to the Registry of Stroke Care Quality data.
Figure 3.
Figure 3.
Median door-to-needle (DNT) and door-to-groin (DGT) times (in min) in stroke-ready hospitals in Estonia from 2017 to 2021 according to the Registry of Stroke Care Quality data.
Figure 4.
Figure 4.
The trend of indicators according to the ANGELS Initiative quality improvement program in Estonia from 2017 to 2021 according to the Registry of Stroke Care Quality data (AF: atrial fibrillation; ICU: intensive care unit; CT: computer tomography; MRI: magnetic resonance imaging).
Figure 5.
Figure 5.
The timeline of developments of stroke care quality in Estonia from 2003 to 2021 (ESO-EAST: European Stroke Organisation – Enhancing and Accelerating Stroke Treatments project; IVT: intravenous thrombolysis; MT: mechanical thrombectomy; RES-Q: Registry of Stroke Care Quality; SITS: Safe Implementation of Treatments in Stroke).
See this image and copyright information in PMC

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