Published Online
on February 6, 2003

A more recent version of this article appeared on March 1, 2003

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Submitted on September 12, 2002
Accepted on September 25, 2002

Relationship Between Process and Outcome in Stroke Care

Harry McNaughton PhD^*; Kathryn McPherson PhD; William Taylor FRACP; and Mark Weatherall FRACP

From the Medical Research Institute of New Zealand, Wellington (H.M.); Health and Rehabilitation Research Unit, School of Health Professions, University of Southampton, Southampton, UK (K.M.); and Rehabilitation Teaching and Research Unit, Wellington School of Medicine and Health Sciences, University of Otago, Otago, New Zealand (W.T., M.W.).

^* To whom correspondence should be addressed. E-mail: hkmcn{at}paradise.net.nz.

Background and Purpose--Better processes in stroke care are assumed to lead to better stroke outcomes. We sought to test whether current measures of stroke process are related to measures of stroke outcome.

Methods--This was a prospective study of consecutive patients with acute stroke admitted to each of the 3 general hospitals in 1 region who were followed up for 12 months after hospital discharge. Process was measured by use of the Royal College of Physicians Stroke Audit Package, and outcomes were measured with a range of disability, health status, handicap, and independence measures, as well as mortality.

Results--One hundred eighty-one patients were recruited. There was evidence for a relationship between some process variables and outcomes at hospital discharge, but the relationships were generally weak. None of the process variables remained in regression models of functional outcomes at 12 months. The hospital with the best process scores had the worst case mix-adjusted outcomes.

Conclusions--The link between stroke process and outcome, through the use of currently available measures of process such as the Royal College of Physicians Stroke Audit Package, is not straightforward. Ongoing work may clarify some of these issues and provide guidance to stroke clinicians on how best to improve existing services.

Key words: outcome • process assessment (health care) • stroke

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