Cross-National Key Performance Measures of the Quality of Acute Stroke Care in Western Europe.
OBJECTIVE
There are no agreed measures of stroke care quality that enable the standardized comparison of stroke care between countries. We aimed to develop a set of measures of quality of acute stroke care involving stroke quality registers in Western Europe.


METHODS
A multinational working group identified 6 regional or national stroke quality registers in Europe and reviewed their data sets, performance measures, and the method by which these had been developed. Measures used in the registers were presented for discussion to a consensus group of representatives from the quality registers identified, as well as other stroke experts, and the final set of common performance measures was agreed through majority consensus.


RESULTS
Thirty final performance measures were agreed by the European consensus group, encompassing the domains of coordination of care (stroke unit-based care), diagnosis (brain imaging, vascular imaging, cardiac arrhythmia detection, and therapy assessment), preservation of neural tissue (thrombolytic therapy and door-to-needle time), prevention of complications (dysphagia screening), initiation of secondary prevention (antiplatelet, anticoagulation, lipid lowering, blood pressure lowering, carotid surgery, time from vascular imaging to carotid surgery, and smoking cessation), survival (90-day poststroke mortality), and functional outcomes (90-day modified Rankin Scale).


CONCLUSIONS
On the basis of experience of quality registers in Europe, we have proposed a common set of performance measures that will facilitate the international comparison of acute stroke care quality.
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Bo
B
Norrving
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.). benjamin.bray@kcl.ac.uk.
Benjamin D
BD
Bray
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Kjell
K
Asplund
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Peter
P
Heuschmann
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Peter
P
Langhorne
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Anthony G
AG
Rudd
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Markus
M
Wagner
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Silke
S
Wiedmann
From the Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.); Division for Health and Social Care Research, King's College London, London, United Kingdom (B.D.B., A.G.R., C.D.A.W.); Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (K.A.); Institute of Clinical Epidemiology and Biometry, Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany (P.H., S.W.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.); National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (A.G.R., C.D.A.W.); and Department of Integrated Care, German Stroke Foundation, Gütersloh, Germany (M.W.).
Charles D A
CD
Wolfe
D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis; D015331:Cohort Studies; D032921:Consensus; D057510:Endovascular Procedures / Q000592:standards; D005060:Europe; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012042:Registries; D055502:Secondary Prevention / Q000592:standards; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000592:standards; D061665:Time-to-Treatment / Q000592:standards
D000925:Anticoagulants; D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors
Europe; blood pressure; quality indicators, health care; quality of healthcare; stroke