title: Variations in acute hospital stroke care and factors influencing adherence to quality indicators in 6 European audits.
abstract: OBJECTIVE
  We compared compliance with standards of acute stroke care between 6 European audits and identified factors associated with delivery of appropriate care.
  
  
  METHODS
  Data were derived from stroke audits in Germany, Poland, Scotland, Catalonia, Sweden, and England/Wales/Northern-Ireland participating within the European Implementation Score (EIS) collaboration. Associations between demographic and clinical characteristics with adherence to predefined quality indicators were investigated by hierarchical logistic regression analyses.
  
  
  RESULTS
  In 2007/2008 data from 329 122 patients with stroke were documented. Substantial variations in adherence to quality indicators were found; older age was associated with a lower probability of receiving thrombolytic therapy, anticoagulant therapy, or stroke unit treatment and a higher probability of being tested for dysphagia. Women were less likely to receive anticoagulant or antiplatelet therapy or stroke unit treatment. No major weekend effect was found.
  
  
  CONCLUSIONS
  Detected variations in performance of acute stroke services were found. Differences in adherence to quality indicators might indicate population subgroups with specific needs for improving care delivery.
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom. silke.wiedmann@uni-wuerzburg.de.
authors.forename: Silke
authors.initials: S
authors.lastname: Wiedmann
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Steffi
authors.initials: S
authors.lastname: Hillmann
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Sònia
authors.initials: S
authors.lastname: Abilleira
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Dennis
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Hermanek
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Rudd
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.affiliation: From the Institute of Clinical Epidemiology and Biometry (S.W., S.H., P.U.H.), Comprehensive Heart Failure Centre (S.W., P.U.H.), University of Würzburg, Würzburg, Germany; Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.); Department of Clinical Neurosciences, Western General Hospital, Edinburgh, United Kingdom (M.D.); Bavarian Permanent Working Party for Quality Assurance, Munich, Germany (P.H.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland (M.N.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); and Division of Health and Social Care Research (A.G.R.) and National Institute for Health Research Biomedical Research Centre Guy's & St Thomas' NHS Foundation Trust (C.D.A.W.), King's College London, London, United Kingdom.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards*; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000592:standards*; D008875:Middle Aged; D019984:Quality Indicators, Health Care / Q000592:standards*; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*
keywords: health services research; quality indicators, health care; quality of healthcare; stroke care