title: The quality of acute stroke care- an analysis of evidence-based indicators in 260 000 patients.
abstract: BACKGROUND
  Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date.
  
  
  METHODS
  The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects.
  
  
  RESULTS
  Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6%). Dysphagia screening was documented in 86.2% (range, 74.8-93.1%). For the following indicators, the defined targets were not reached for all of Germany: anti-aggregation within 48 hours, 93.4% (range, 86.6-96.4%); anticoagulation for atrial fibrillation, 77.6% (range, 72.4-80.1%); standardized dysphagia screening, 86.2% (range, 74.8-93.1%); oral and written information of the patients or their relatives, 86.1% (range, 75.4-91.5%). The rate of patients examined or treated by a speech therapist was in the target range.
  
  
  CONCLUSIONS
  The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.
authors.affiliation: Institute of Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, Comprehensive Heart Failure Center (CHFC), University of Würzburg, The Clinical Trial Center, University Hospital Würzburg, German Stroke Society (DSG), Berlin, Office for Quality Assurance in Hospitals (GeQiK), Stuttgart; Baden-Württemberg Hospital Association, Stuttgart, Germany, Department of Neurology, Vivantes-Klinikum Spandau, Berlin, Department of Neurology, Asklepios Klinik Nord, Hamburg, Institute of Quality Assurance Hesse (GQH), Quality Assurance in Stroke Management in North Rhine-Westphalia, Medical Association North Rhine, Quality Assurance Project "Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster, Institute of Quality Assurance Rhineland-Palatinate / SQMed, Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck, Erlangen Community Stroke Registry, Federal Health Reporting (GBE), Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health, Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich.
authors.forename: Silke
authors.initials: S
authors.lastname: Wiedmann
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Steffi
authors.initials: S
authors.lastname: Hillmann
authors.forename: Otto
authors.initials: O
authors.lastname: Busse
authors.forename: Horst
authors.initials: H
authors.lastname: Wiethölter
authors.forename: Georg M
authors.initials: GM
authors.lastname: Walter
authors.forename: Günter
authors.initials: G
authors.lastname: Seidel
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.forename: Alfred
authors.initials: A
authors.lastname: Janssen
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.forename: Christoph
authors.initials: C
authors.lastname: Burmeister
authors.forename: Christine
authors.initials: C
authors.lastname: Matthis
authors.forename: Peter
authors.initials: P
authors.lastname: Kolominsky-Rabas
authors.forename: Peter
authors.initials: P
authors.lastname: Hermaneks
mesh_terms: D017677:Age Distribution; D000368:Aged; D055317:Evidence-Based Practice; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012042:Registries; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome