title: Quality indicators in acute stroke care: a prospective observational survey in 13 Italian regions.
abstract: OBJECTIVE
  Quality monitoring has great relevance in stroke care. The Project "How to guarantee adherence to effective interventions in stroke care" aimed to estimate adherence to acute-phase guidelines in stroke care in Italy.
  
  
  METHODS
  A prospective observational study was performed in 27 hospitals of 13 Italian Regions. Adherence to 15 process indicators was evaluated, comparing also stroke units (SU) with conventional wards. An overall score of care, defined as the sum of achieved indicators, was calculated. A multilevel hierarchical model described performance at patient, hospital and regional level.
  
  
  RESULTS
  Overall, 484 consecutive stroke patients (mean age, 73.4 years; 52.7 % males) were included. Total score ranged from 2 to 15 (mean 8.5 ± 2.4). SU patients were more often evaluated with the National Institutes of Health Stroke Scale (NIHSS) within 24 h, had more frequently an assessment of pre- and post-stroke disability, and a CT scan the same or the day after admission. Regional-hospital- and patient-level variability explained, respectively, 25, 34, and 41 % of total score variance. In multivariate models, patients >80 years vs. younger showed a change in total score of -0.45 (95 % CI -0.79 to -0.12), and those with NIHSS ≥14 vs. ≤5 of -0.92 (95 % CI -1.53 to -0.30). A negative change means a worse adjusted average adherence to process indicators. SU admission increased total score of 1.55 (95 % CI 0.52-2.58).
  
  
  CONCLUSIONS
  Our data confirm the need of quality monitoring in stroke care. Although SU patients showed a better adherence to quality indicators, overall compliance was unsatisfactory.
authors.affiliation: Institute of Neurosciences, Italian National Research Council, Florence, Italy, dicarlo@in.cnr.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Carlo
authors.forename: Gabriele
authors.initials: G
authors.lastname: Accetta
authors.forename: Marzio
authors.initials: M
authors.lastname: Bellan
authors.forename: Gianna
authors.initials: G
authors.lastname: Terni
authors.forename: Maria
authors.initials: M
authors.lastname: Lamassa
authors.forename: Rebecca
authors.initials: R
authors.lastname: Facchini
authors.forename: Annibale
authors.initials: A
authors.lastname: Biggeri
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
authors.forename: Salvatore
authors.initials: S
authors.lastname: Ferro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D059039:Standard of Care; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*