title: Stroke service: how can we improve and measure outcomes? Consensus summary from a global stroke forum.
abstract: The success of acute stroke treatment is first and foremost time-dependent, and the need for improvement in acute stroke management is demonstrated by the fact that only a minority of patients gain access to treatment - in particular, intravenous recombinant tissue plasminogen activator (IV tPA) - within the necessary time window. Standards of acute stroke care vary widely both regionally and nationally; consequently, various healthcare organizations have undertaken initiatives to measure and improve quality of care. To date, most quality measures have been process-based, focusing primarily on metrics of patient care in the acute hospital-based setting (e.g., time to recombinant tPA administration). Therefore, there remains a need for metrics designed to assess how improvements in process translate into patient outcomes. A global forum was convened to share best practice and provide consensus recommendations on core metrics for measuring improvements in access to care and patient outcomes. Recommendations for core metrics of patient outcomes include hospital-based outcomes (e.g., neurological status at 24 h, ambulatory status at discharge) and post-discharge outcomes (e.g., modified Rankin Scale score at 30 and/or 90 days). Recommendations for best practice relating to aspects of people, process, and technology involved in the stroke treatment pathway that may help provide improvements in these core outcome measures are also outlined.
authors.affiliation: The University of Kansas Hospital, Kansas City, KS, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Rymer
authors.forename: C S
authors.initials: CS
authors.lastname: Anderson
authors.forename: M
authors.initials: M
authors.lastname: Harada
authors.forename: J
authors.initials: J
authors.lastname: Jarosz
authors.forename: N
authors.initials: N
authors.lastname: Ma
authors.forename: H A
authors.initials: HA
authors.lastname: Rowley
authors.forename: D
authors.initials: D
authors.lastname: Summers
authors.forename: K
authors.initials: K
authors.lastname: Tastula
authors.forename: O
authors.initials: O
authors.lastname: Williams
authors.forename: N M
authors.initials: NM
authors.lastname: Bornstein
mesh_terms: D023381:Endpoint Determination; D006801:Humans; D011994:Recombinant Proteins / Q000008:administration & dosage; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: acute stroke; health services; management; outcome metrics; quality measures; recombinant tissue plasminogen activator