Evidence-based quality indicators for stroke rehabilitation.
OBJECTIVE
Previous stroke performance measures consider aspects of postacute treatment, but there are only few specific quality indicators or standards for poststroke rehabilitation. The purpose of this study was to develop a set of indicators for measuring the quality of postacute stroke rehabilitation in inpatient and outpatient facilities using a standardized evidence-based approach.


METHODS
Quality indicators were developed between January 2009 and February 2010 by an interdisciplinary board of healthcare professionals from rehabilitation centers cooperating in the Berlin Stroke Alliance. The Berlin Stroke Alliance is a regional network of >40 providers of acute treatment, rehabilitation, and aftercare aiming to improve stroke services within Berlin and Brandenburg. The indicators were developed according to published international recommendations and predefined methodological requirements. The applied standards included a systematic literature review, a rating of published evidence, an external peer review, and the evaluation in a pilot study before implementation.


RESULTS
Of an initial list of 33 indicators, 20 indicators were rated as being appropriate. After completion of the pilot phase, we agreed on a set of 18 indicators. The indicators measure processes (9 indicators), outcomes (5 indicators), and structures (4 indicators) in the following domains of stroke rehabilitation: completion of diagnostics; secondary prevention; cognition and affect; speech and swallowing; management of complications; sensorimotor functions and mobility; discharge status; and aftercare.


CONCLUSIONS
Documentation of evidence-based quality indicators for stroke rehabilitation in clinical routine is feasible and can serve as a first step toward implementing standardized cross-institutional quality assurance programs for stroke rehabilitation.
Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. maike.grube@charite.de
Maike M
MM
Grube
Christian
C
Dohle
Diana
D
Djouchadar
Petra
P
Rech
Karen
K
Bienek
Ursula
U
Dietz-Fricke
Michael
M
Jöbges
Martin
M
Kohler
Isabelle
I
Missala
Bertram
B
Schönherr
Cordula
C
Werner
Helen
H
Zeytountchian
Jörg
J
Wissel
Peter U
PU
Heuschmann
D055317:Evidence-Based Practice; D006801:Humans; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome