title: Developing a tool to assess quality of stroke care across European populations: the EROS Quality Assessment Tool.
abstract: OBJECTIVE
  There are significant differences in the provision of care and outcome after stroke across countries. The European Registers of Stroke study aimed to develop, test, and refine a tool to assess quality of care.
  
  
  METHODS
  We used a systematic review and grading of evidence for stroke care across the clinical pathway and developed and field-tested a quality tool that was delivered by post and later by site visit at 7 centers. Items were refined by using an algorithm that took into account the level of evidence, measurement properties, and consensus of opinion obtained using, the Delphi techniques.
  
  
  RESULTS
  The tool included 251 items across 11 domains, of which 214 items could be categorized by any level of evidence. Overall agreement between postal and site visit modes of delivery was acceptable (κ=0.77), with most items having a κ>0.5. The refinement process resulted in 2 practical versions of the tool (93 items and 22 items). Positive responses to items in the tool indicated implementation of evidence-based stroke care. In field testing, the proportion of positive responses to evidence-based items ranged from 43% to 79% across populations. Proportions of different types of evidence being implemented were similar: high quality 62%, limited quality 72%, and expert opinion 54% across the populations. More than half (4 of 7) of the centers provided stroke unit care and thrombolysis, but availability and access to inpatient rehabilitation varied significantly, with poor access to community follow-up for rehabilitation and medical management.
  
  
  CONCLUSIONS
  The European Registers of Stroke Quality Assessment Tool has potential to be used as a framework to compare services and promote increased implementation of evidence-based care.
authors.affiliation: Division of Health and Social Care Research, King's College London, King's College Hospital NHS Foundation Trust, Guy's Campus, 7th Floor, Capital House, 42 Weston St, London SE1 3QD, UK. ian.wellwood@kcl.ac.uk
authors.forename: Ian
authors.initials: I
authors.lastname: Wellwood
authors.forename: Olivia
authors.initials: O
authors.lastname: Wu
authors.forename: Peter
authors.initials: P
authors.lastname: Langhorne
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Carlo
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
mesh_terms: D000465:Algorithms; D003697:Delphi Technique; D005060:Europe / Q000453:epidemiology; D055317:Evidence-Based Practice; D006801:Humans; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards*; D012042:Registries; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires