[Clinical neurologists' views on measures influencing the quality of acute stroke care].
BACKGROUND
Legislation, professional medical societies and health care providers urge neurological departments to increase focus on more effective structures and processes. This, however, depends on the appreciation of quality features by the physicians involved.


OBJECTIVE
The present study aimed to identify neurologists' subjective quality criteria, the analysis of influential factors, and a comparison with existing guidelines.


METHODS
In a multicentre survey, 99 registrars and senior registrars from 30 clinical departments of neurology were interviewed. The data were analysed both quantitatively and qualitatively.


RESULTS
In the participants' view, the quality of acute stroke care depends upon access to competent care, optimal acute management and the presence of trained and experienced personnel. Some subjective dimensions of service quality are dependent upon the interviewed neurologist's board certification status and the features of the respective department (stroke caseload, implementation of a stroke guideline). In comparison to national guidelines, early secondary prevention is underreported. Interviewed neurologists and guidelines agree on the importance of rapid diagnostic procedures and continuous monitoring.


CONCLUSIONS
The focus upon early and rapid diagnosis and treatment underlines the importance of optimal emergency organisation for acute stroke patients. Early secondary prophylaxis, the prevention of complications and rehabilitation management are underestimated as relevant fields of action. Empirical research and medical education should address possible deficits concerning these aspects.
Hasenbein
Uwe
U
Institut für Neurologisch-Neurochirurgische Rehabilitationsforschung, Magdeburg. hasenbein@innrf.de
Schulze
Axel
A
Sauermann
Wolfgang
W
Wallesch
Claus-Werner
CW
D002568:Certification; D005858:Germany; D006801:Humans; D007883:Legislation, Medical; D009462:Neurology / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D020521:Stroke / Q000628:therapy*