title: Processes and outcomes of ischemic stroke care: the influence of hospital level of care.
abstract: OBJECTIVE
  Processes of stroke care play an increasingly important role in comparing hospital performance. The relationship between processes of care and outcomes for stroke is unclear. Moreover, in terms of stroke care regionalization, little information is available with regard to the relationships among hospital level of care, processes and outcomes of stroke care. We used nationwide population-based data to examine the relationship between processes of care and mortality and the relationships among hospital level of care, processes and mortality for ischemic stroke.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  General acute care hospitals throughout Taiwan.
  
  
  METHODS
  A total of 31 274 ischemic stroke patients admitted in 2010 through Taiwan's National Health Insurance Research Database.
  
  
  METHODS
  Processes of care and 30-day mortality. Multilevel models were used after adjustment for patient and hospital characteristics to test the relationship between processes of care and 30-day mortality and the relationships among hospital level of care, processes and 30-day mortality.
  
  
  RESULTS
  The use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment was associated with lower mortality. Hospital level of care was associated with the use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment, and mortality. These processes of care were mediators of the relationship between hospital level of care and mortality.
  
  
  CONCLUSIONS
  Outcomes among patients with ischemic stroke can be improved by thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment. Among patients with ischemic stroke, admission to designated stroke center hospitals may be associated with lower mortality through better processes of care.
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Chi
authors.initials: YC
authors.lastname: Tung
authors.affiliation: Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
authors.affiliation: Department of Family Medicine, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors.forename: Guann-Ming
authors.initials: GM
authors.lastname: Chang
authors.affiliation: Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
authors.forename: Kuo-Piao
authors.initials: KP
authors.lastname: Chung
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000401:mortality / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality / Q000628:therapy*; D013624:Taiwan / Q000453:epidemiology
keywords: cerebrovascular disease; hospital care; patient outcomes; quality indicators