title: Relationship between process and outcome in stroke care.
abstract: OBJECTIVE
  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.
authors.affiliation: Medical Research Institute of New Zealand, PO Box 10055, Wellington, New Zealand. hkmcn@paradise.net.nz
authors.forename: Harry
authors.initials: H
authors.lastname: McNaughton
authors.forename: Kathryn
authors.initials: K
authors.lastname: McPherson
authors.forename: William
authors.initials: W
authors.lastname: Taylor
authors.forename: Mark
authors.initials: M
authors.lastname: Weatherall
mesh_terms: D000208:Acute Disease; D000368:Aged; D015331:Cohort Studies; D003710:Demography; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000401:mortality; D000071939:Stroke Rehabilitation