Quality of in-hospital stroke care according to evidence-based performance measures: results from the first audit of stroke, Catalonia, Spain.
OBJECTIVE
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 >or=75%, 4 of which were more than 90%, and the remaining showed adherences <or=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.
Abilleira
Sònia
S
Ministry of Health of the Autonomous Government of Catalonia, Catalan Agency for Health Technology Assessment and Research, Barcelona, Spain. sabilleira@aatrm.catsalut.net
Gallofré
Miquel
M
Ribera
Aida
A
Sánchez
Emília
E
Tresserras
Ricard
R
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015999:Multivariate Analysis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013030:Spain; D020521:Stroke / Q000628:therapy*