Benchmarks and determinants of adherence to stroke performance measures.
OBJECTIVE
Develop achievable benchmarks for 9 stroke performance measures (PM) and to identify organizational factors associated with adherence.


METHODS
Adherence rates and achievable benchmarks were determined for 9 PM within a study of patients (n=2294) admitted with acute ischemic stroke at 17 hospitals. Baseline information regarding hospital characteristics and stroke-specific processes of care were collected, and multi-level models were used to test the association of these factors with adherence.


RESULTS
Benchmarks were >or=90% for 8 of the 9 PM. After controlling for clustering, only use of standing orders was associated with adherence to PM, including: dysphagia screening, venous thrombosis prophylaxis, consideration of tPA, and provision of educational material.


CONCLUSIONS
High levels of adherence are achievable for several acute stroke PM. Use of standing orders is associated with adherence to PM requiring immediate action on admission.
Hinchey
Judith A
JA
Shephard
Timothy
T
Tonn
Sarah T
ST
Ruthazer
Robin
R
Selker
Harry P
HP
Kent
David M
DM
D000368:Aged; D019985:Benchmarking / Q000379:methods*; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010353:Patient Education as Topic / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014481:United States; D020246:Venous Thrombosis / Q000188:drug therapy / Q000517:prevention & control
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator