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(Stroke. 2006;37:2573.)
© 2006 American Heart Association, Inc.

Original Contributions

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)

Peter U. Heuschmann, MD, MPH; Marcel K. Biegler, MD; Otto Busse, MD; Susanne Elsner, MD; Armin Grau, MD; Uwe Hasenbein, MSc; Peter Hermanek, MD; Rudolf W.C. Janzen, MD; Peter L. Kolominsky-Rabas, MD; Klaus Kraywinkel, MD, MSc; Klaus Lowitzsch, MD; Bjoern Misselwitz, MD, MPH; Darius G. Nabavi, MD; Kirsten Otten, MD, MPH; Ludger Pientka, MD; Gerhard M. von Reutern, MD; Erich Bernd Ringelstein, MD; Dirk Sander, MD; Markus Wagner, PhD Klaus Berger, MD, MPH

From the Coordination Office and Central Data Centre of the ADSR, Stroke Register Northwest-Germany (P.U.H., K.B.), Institute of Epidemiology and Social Medicine (P.U.H., K.B., K.K.), University of Muenster, Stroke Register Rhineland-Palatinate (M.K.B., A.G., K.L.), Regional Office for Quality Assurance Rhineland-Palatinate (M.K.B.), SQMed gGmbH, Mainz, Department of Neurology (A.G., K.L.), Klinikum Ludwigshafen; German Stroke Society (O.B., E.B.R.), Commission "Stroke Units and Acute Stroke Treatment" of the German Stroke Society (E.B.R.), Department of Neurology (E.B.R., D.G.N.), University of Muenster, Commission "Health Care Research" of the German Stroke Society (P.K.R.), Unit for Stroke Research and Public Health Medicine (P.K.R.), University of Erlangen-Nuremberg; German Society of Neurology (O.B.), Minden, Commission "Quality Management" of the German Society of Neurology (R.W.C.J.), Frankfurt; Stroke Register Baden-Wuerttemberg (S.E.), Regional Office for Quality Assurance Baden-Wuerttemberg (GeQik), Stuttgart; Institute for Neurological-Neurosurgical Rehabilitation Research (U.H.), University of Magdeburg; Stroke Register Bavaria (P.H.), Regional Office for Quality Assurance Bavaria (BAQ), Munich; Stroke Register Hesse (B.M., G.M.v.R., R.W.C.J.), Regional Office for Quality Assurance Hesse (GQH) (B.M.), Eschborn, Department of Neurology (G.M.v.R.), Asklepios Klinik Bad Salzhausen, Nidda; Stroke Register North-Rhine (K.O.), Institute for Quality in Health Care North-Rhine (IQN), Duesseldorf; Department of Geriatric Medicine (L.P.), Ruhr University, Herne; Department of Neurology (D.S.), University of Munich; German Stroke Foundation (M.W.), Guetersloh, Germany.

Correspondence to Peter U. Heuschmann, MD, MPH, Institute of Epidemiology and Social Medicine, University of Münster, Domagkstr. 3, 48149 Münster. E-mail heuschma{at}uni-muenster.de

Background and Purpose— There is no consensus about indicators for measuring quality of acute stroke care in Germany. Therefore, a standardized process was initiated recently to develop and implement evidence-based indicators for the measurement of quality of acute hospital stroke care.

Methods— Quality indicators were developed by a multidisciplinary board between November 2003 and December 2005. The process was initiated by the German Stroke Registers Study Group in cooperation with the German Stroke Society, the German Society of Neurology, the German Stroke Foundation, Regional Offices for Quality Assurance and other experts proven in the field. National and international recommendations were considered during the development process. The process was based on a systematic literature review, an independent external evaluation of the process and its results, and a prospective pilot study to evaluate the defined indicators in clinical practice.

Results— Overall a set of 24 indicators was developed to measure performance of acute care hospitals in the 3 health care dimensions structure, process and outcome as well as in 3 treatment phases prehospital, in-hospital/acute and postacute. Practicability of the derived indicators was tested in a prospective pilot study. During a 2-month period, 1006 patients in 13 hospitals were documented. Application of the new indicator set was found to be feasible by participating physicians and hospitals. Median time to document the required information for 1 patient was 5 minutes. Nationwide implementation of the new indicator set within regional registers in Germany started since April 2006.

Conclusions— The development of indicators to measure hospital performance in stroke care is an important step toward improving stroke care on a national level. The chosen standardized evidence-based approach ensures maximal transparency, acceptance and sustainability of the developed indicators in Germany.

Key Words: acute care • quality indicators • stroke

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