title: Stroke unit care in germany: the german stroke registers study group (ADSR).
abstract: BACKGROUND
  Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.
  
  
  METHODS
  Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.
  
  
  RESULTS
  In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.
  
  
  CONCLUSIONS
  Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.
authors.affiliation: Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany. steffi.hillmann@uni-wuerzburg.de.
authors.forename: Steffi
authors.initials: S
authors.lastname: Hillmann
authors.affiliation: Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany.|Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Wiedmann
authors.affiliation: Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Rücker
authors.affiliation: Quality Assurance Project"Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D3, 48149, Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Rudower Straße 48, 12351, Berlin, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Nabavi
authors.affiliation: Office for Quality Assurance in Hospitals (GeQiK) Stuttgart at Baden-Wuerttembergische Hospital Federation, Stuttgart, Birkenwaldstr. 151, 70191, Stuttgart, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Bruder
authors.affiliation: Vivantes Klinikum im Friedrichshain, Berlin, Landsberger Allee 49, 10249, Berlin, Germany.
authors.forename: Hans-Christian
authors.initials: HC
authors.lastname: Koennecke
authors.affiliation: Department of Neurology, Asklepios Klinik Nord, Hamburg,, Tangstedter Landstraße 400, 22417, Hamburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Seidel
authors.affiliation: Institute of Quality Assurance Hesse (GQH), Frankfurter Str. 10, 65760, Eschborn, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Misselwitz
authors.affiliation: Quality Assurance in Stroke Management in North Rhine-Westphalia, Medical Association North Rhine, Tersteegenstr. 9, 40474, Düsseldorf, Germany.
authors.forename: Alfred
authors.initials: A
authors.lastname: Janssen
authors.affiliation: Institute of Quality Assurance Rhineland-Palatinate / SQMed, Wilhelm-Theodor-Römheld-Straße 34, 55130, Mainz, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Burmeister
authors.affiliation: Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Matthis
authors.affiliation: German Stroke Society, Berlin, Reinhardtstr. 27C, 10117, Berlin, Germany.
authors.forename: Otto
authors.initials: O
authors.lastname: Busse
authors.affiliation: Bavarian Permanent Working Party for Quality Assurance, Munich, Westenriederstr. 19, 80331, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hermanek
authors.affiliation: Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany.|Comprehensive Heart Failure Center, University of Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany.|Clinical Trial Center Würzburg, University Hospital Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany.
authors.forename: Peter Ulrich
authors.initials: PU
authors.lastname: Heuschmann
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology / Q000628:therapy*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D012042:Registries / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*
keywords: Quality indicators; Quality of health care; Stroke register; Stroke unit care