title: Variations in quality indicators of acute stroke care in 6 European countries: the European Implementation Score (EIS) Collaboration.
abstract: OBJECTIVE
  Quality indicators serve as standards of care by which performance of individual hospitals is measured. Although several audits for monitoring quality of stroke care have been established in Europe, there is currently no consensus on quality indicators for acute stroke care or for methodology for collecting information on these measures.
  
  
  METHODS
  An up-to-date inventory on European stroke audits in place in 2006 was performed in the course of a project funded by the European Union (European Implementation Score Collaboration [EIS]). Two regional (Flanders, Belgium; Catalonia, Spain) and 4 national (Germany, Scotland, Sweden, England/Wales/Northern Ireland) stroke audits took part. Between November 2009 and July 2010, 2 standardized surveys and a series of interviews were performed to determine characteristics, methods, and content of these quality initiatives. For quality purposes, all summarized information was validated by representatives of the respective audits.
  
  
  RESULTS
  Overall, 123 quality indicators (91 process, 24 outcome, and 8 structural indicators) were identified. Anticoagulants in patients with atrial fibrillation and brain imaging were the only quality indicators used in all, whereas another 13 indicators were used in at least 2 of the quality initiatives. Substantial variations were found across the audits in terms of the development process of quality indicators, inclusion criteria, participation, population coverage, data documentation, follow-ups, benchmarking, and feedback of results to participants.
  
  
  CONCLUSIONS
  There is a huge variety in measuring performance of acute stroke care in Europe, hampering valid comparisons of acute stroke care. Common standards for defining quality indicators and collecting information required for these measures should be defined in Europe.
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, Petrinistr. 33a, 97080 Würzburg, Germany. silke.wiedmann@uni-wuerzburg.de
authors.forename: Silke
authors.initials: S
authors.lastname: Wiedmann
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.forename: Tim
authors.initials: T
authors.lastname: Nowe
authors.forename: Sònia
authors.initials: S
authors.lastname: Abilleira
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.forename: Martin
authors.initials: M
authors.lastname: Dennis
authors.forename: Peter
authors.initials: P
authors.lastname: Hermanek
authors.forename: Anthony
authors.initials: A
authors.lastname: Rudd
authors.forename: Vincent
authors.initials: V
authors.lastname: Thijs
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D019985:Benchmarking; D003627:Data Interpretation, Statistical; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004282:Documentation; D005060:Europe; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017408:Guidelines as Topic; D006284:Health Plan Implementation / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008485:Medical Audit; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D000071939:Stroke Rehabilitation; D015912:Thrombolytic Therapy
chemical_list: D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors