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).
OBJECTIVE
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.
Heuschmann
Peter U
PU
Institute of Epidemiology and Social Medicine, University of Münster, Domagkstr. 3, 48149 Münster, Germany. heuschma@uni-muenster.de
Biegler
Marcel K
MK
Busse
Otto
O
Elsner
Susanne
S
Grau
Armin
A
Hasenbein
Uwe
U
Hermanek
Peter
P
Janzen
Rudolf W C
RW
Kolominsky-Rabas
Peter L
PL
Kolominisky-Rabas
Peter L
PL
Kraywinkel
Klaus
K
Lowitzsch
Klaus
K
Misselwitz
Bjoern
B
Nabavi
Darius G
DG
Otten
Kirsten
K
Pientka
Ludger
L
von Reutern
Gerhard M
GM
Ringelstein
Erich Bernd
EB
Sander
Dirk
D
Wagner
Markus
M
Berger
Klaus
K
D000208:Acute Disease; D019317:Evidence-Based Medicine; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D011785:Quality Assurance, Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013997:Time Factors