Quality monitoring of acute stroke care in Rhineland-Palatinate, Germany, 2001-2006.
OBJECTIVE
Quality monitoring projects are useful tools to improve the quality and to assess temporal trends of stroke care in larger populations.


METHODS
In Rhineland-Palatinate, Germany, a statewide, hospital-based, acute stroke care quality monitoring project was started in 2001. Initially, participation was mandatory for all hospitals with dedicated stroke units and from 2006 onward was mandatory for all hospitals. Quality monitoring included a structured data assessment and quality indicators for procedural measures.


RESULTS
Between 2001 and 2006, the numbers of patients registered annually (N=6389 vs N=10 610), admission <3 hours after stroke onset (28.2% vs 34.6%), admission via emergency medical systems (38.1% vs 50.3%), and treatment in stroke units (44.3% vs 59.5%) increased significantly (P<0.0001, respectively). In ischemic stroke, use of thrombolytic therapy increased (for patients admitted <3 hours after onset, 6.5% vs 14.1%), whereas therapy with high-dose heparin declined (24.5% vs 6.0%, P<0.0001). Several quality indicators (performance of neuroimaging and Doppler/duplex sonography, neuroimaging <3 hours after admission) showed stable results at a high level; more patients received echocardiography (62.2% vs 74.0%), but fewer patients were rapidly examined by extracranial Doppler/duplex sonography (68.7% vs 62.8%, P<0.0001). Diagnosis and treatment of hypertension and hyperlipidemia, use of aspirin and combined aspirin/dipyridamole, and diagnosis of atrial fibrillation increased (P<0.0001, respectively). Use of oral anticoagulation remained stable at approximately 38% of patients with cardioembolism.


CONCLUSIONS
Although these results reflect high standards of acute stroke care and improvements regarding early admission, thrombolytic therapy, and several secondary preventive measures, there is still the potential for further improvement regarding thrombolysis, use of oral anticoagulation and statins, and admission to stroke units, for example.
Department of Neurology, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany. graua@klilu.de
Armin J
AJ
Grau
Martin
M
Eicke
Marcel K
MK
Biegler
Andreas
A
Faldum
Christian
C
Bamberg
Anton
A
Haass
Roland
R
Hardt
Andreas
A
Hufschmidt
Klaus
K
Lowitzsch
Jürgen
J
Marx
Eberhard
E
Schmitt
Hartmut
H
Schoenemann
Wolf
W
von Arnim
Hagen
H
Weiss
Sieghard
S
Dienlin
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries / Q000592:standards; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D013997:Time Factors