Alves Monique Bueno, Silva Gisele Sampaio, Miranda Renata Carolina Acri, Massaud Rodrigo Meireles, Vaccari Andreia Maria Heins, Cendoroglo-Neto Miguel, Diccini Solange
Universidade Federal de São Paulo, São Paulo, Brazil; Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Universidade Federal de São Paulo, São Paulo, Brazil; Programa Integrado de Neurologia and Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, São Paulo, Brazil.
J Stroke Cerebrovasc Dis. 2017 Oct;26(10):2256-2263. doi: 10.1016/j.jstrokecerebrovasdis.2017.05.008. Epub 2017 Jun 20.
Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital.
We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed. We also compared 5 quality indicators available from a secondary community hospital for the first year of the series to those found in the tertiary hospital.
We evaluated 551 patients at the tertiary stroke center (median age 77.0 years [interquartile range 64.0-84.0]; 58.4% were men). The quality indicators that improved with time were the use of cholesterol-lowering therapy (P = .02) and stroke education (P = .04). The median composite perfect care did not consistently improve throughout the period (P = .13). After a multivariable adjustment, only thrombolytic treatment (odds ratio [OR] 2.06, P < .01), dyslipidemia (OR 2.03, P < .01), and discharge in a Joint Commission International's (JCI) visit year (OR 1.8, P < .01) remained as predictors of a perfect care index of 85% or higher. The quality indicators with worse performance (anticoagulation for atrial fibrillation and cholesterol reduction) were similar in the tertiary and secondary community hospitals.
We found a significant improvement in some quality indicators across the years in a PSC located in Latin America. The overall perfect care measure did not improve and was influenced by being discharged in a JCI visit year, having dyslipidemia, and having undergone thrombolytic treatment.
