title: Temporal Changes in the Quality of Acute Stroke Care in Five National Audits across Europe.
abstract: Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care.
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080 Würzburg, Germany.
authors.forename: Steffi
authors.initials: S
authors.lastname: Hillmann
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080 Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, 97080 Würzburg, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Wiedmann
authors.affiliation: Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Alec
authors.initials: A
authors.lastname: Fraser
authors.affiliation: Department of Management, School of Social Science and Public Policy, King's College London, London SE1 3QD, UK.
authors.forename: Juan
authors.initials: J
authors.lastname: Baeza
authors.affiliation: Division of Health and Social Care Research, King's College London, London SE1 1UL, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Rudd
authors.affiliation: Department of Clinical Sciences, Neurology, Lund University, 221 00 Lund, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
authors.affiliation: Department of Public Health and Clinical Medicine, Umeå University, Umeå 901 85, Sweden.
authors.forename: Kjell
authors.initials: K
authors.lastname: Asplund
authors.affiliation: Department of Experimental and Clinical Pharmacology, Medical University Warsaw, 02-091 Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.affiliation: Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Dennis
authors.affiliation: Bavarian Permanent Working Party for Quality Assurance, 80331 Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hermanek
authors.affiliation: Division of Health and Social Care Research, King's College London, London SE1 1UL, UK; National Institute for Health Research Biomedical Research, Centre Guy's & St Thomas' NHS Foundation Trust and King's College London, London SE1 9RT, UK.
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.affiliation: Institute of Clinical Epidemiology and Biometry, University of Würzburg, 97080 Würzburg, Germany; Comprehensive Heart Failure Center, University Hospital of Würzburg, 97080 Würzburg, Germany; Clinical Trial Center Würzburg, University Hospital Würzburg, 97080 Würzburg, Germany.
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D020521:Stroke / Q000473:pathology / Q000628:therapy*; D000071939:Stroke Rehabilitation; D015912:Thrombolytic Therapy
chemical_list: D005343:Fibrinolytic Agents