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(Stroke. 2009;40:1433.)
© 2009 American Heart Association, Inc.

Original Contributions

Quality of In-Hospital Stroke Care According to Evidence-Based Performance Measures

Results From the First Audit of Stroke, Catalonia (Spain) 2005/2006

Sònia Abilleira, MD, PhD; Miquel Gallofré, MD; Aida Ribera, BSc, PhD; Emília Sánchez, MD, MPH, PhD Ricard Tresserras, MD, MPH, PhD

From the Stroke Programme, General Directorate for Planning and Evaluation, Ministry of Health of the Autonomous Government of Catalonia (S.A., R.T., M.G.); the Catalan Agency for Health Technology Assessment and Research (CAHTA) (S.A., E.S.); the Cardiovascular Epidemiology Unit (A.R.), Hospital Vall d’Hebron, Barcelona; and CIBER Epidemiología y Salud Pública (CIBERESP) (A.R., E.S.), Spain; Facultat de Medicina, Universitat Autonoma de Barcelona (M.G.).

Correspondence to Sònia Abilleira, MD, PhD, Catalan Agency for Health Technology Assessment and Research (CAHTA), C/ Roc Boronat 81-95, 2a planta 08005 Barcelona, Spain. E-mail sabilleira{at}aatrm.catsalut.net

Background and Purpose— Evidence-based standards are used worldwide to determine quality of care. We assessed quality of in-hospital stroke care in all acute-care hospitals in Catalonia by determining adherence to 13 evidence-based performance measures (PMs) of process of care.

Methods— Data on PMs were collected by retrospective review of medical records of consecutive stroke admissions (January to June, 2005). Compliance with PMs was calculated according to 3 hospital levels determined by their annual stroke case-load (level 1, <150 admissions/yr; level 2, 150 to 350; and level 3, >350). We defined sampling weights that represented each patient’s inverse probability of inclusion in the study sample. Sampling weights were applied to produce estimates of compliance. Factors that predicted good/bad compliance were determined by multivariate weighted logistic regression models. An external monitoring of 10% of cases recruited at each hospital was undertaken, after random selection, to assess quality of data.

Results— We analyzed data from 1791 stroke cases (17% of all stroke admissions). Global interobserver agreement was 0.7. Eight PMs achieved compliances 75%, 4 of which were more than 90%, and the remaining showed adherences 62%. Analysis of compliance across hospital levels displayed some significant differences that persisted after multivariate analysis. We observed lower adherences to "early mobilization," "assessment of rehabilitation needs," and "prescription of anticoagulants for atrial fibrillation" in females and in the elderly.

Conclusions— In 2005, in-hospital stroke care in Catalonia was heterogeneous across hospital levels. Rehabilitation-related measures showed poor compliances compared to acute care-related ones, which achieved more satisfactory adherences.

Key Words: clinical audit • quality of health care • process assessment (health care) • stroke