Institute of Clinical Epidemiology and Biometry, University of Würzburg (K.H., V.R., P.U.H.).
Bavarian Permanent Working Party for Quality Assurance (BAQ), Munich (P.H.).
Stroke. 2020 Dec;51(12):3664-3672. doi: 10.1161/STROKEAHA.120.029968. Epub 2020 Oct 12.
Quality indicators (QI) are an accepted tool to measure performance of hospitals in routine care. We investigated the association between quality of acute stroke care defined by overall adherence to evidence-based QI and early outcome in German acute care hospitals.
Patients with ischemic stroke admitted to one of the hospitals cooperating within the ADSR (German Stroke Register Study Group) were analyzed. The ADSR is a voluntary network of 9 regional stroke registers monitoring quality of acute stroke care across 736 hospitals in Germany. Quality of stroke care was defined by adherence to 11 evidence-based indicators of early processes of stroke care. The correlation between overall adherence to QI with outcome was investigated by assessing the association between 7-day in-hospital mortality with the proportion of QI fulfilled from the total number of QI the individual patient was eligible for. Generalized linear mixed model analysis was performed adjusted for the variables age, sex, National Institutes of Health Stroke Scale and living will and as random effect for the variable hospital.
Between 2015 and 2016, 388 012 patients with ischemic stroke were reported (median age 76 years, 52.4% male). Adherence to distinct QI ranged between 41.0% (thrombolysis in eligible patients) and 95.2% (early physiotherapy). Seven-day in-hospital mortality was 3.4%. The overall proportion of QI fulfilled was median 90% (interquartile range, 75%-100%). In multivariable analysis, a linear association between overall adherence to QI and 7-day in-hospital-mortality was observed (odds ratio adherence <50% versus 100%, 12.7 [95% CI, 11.8-13.7]; <0.001).
Higher quality of care measured by adherence to a set of evidence-based process QI for the early phase of stroke treatment was associated with lower in-hospital mortality.
质量指标（QI）是一种用于衡量医院常规护理绩效的公认工具。我们研究了通过整体遵循基于证据的 QI 定义的急性脑卒中护理质量与德国急性护理医院早期结果之间的关联。
分析了在参与 ADSR（德国中风登记研究组）的一家医院接受治疗的缺血性中风患者。ADSR 是一个由 9 个区域中风登记处组成的自愿网络，监测德国 736 家医院的急性中风护理质量。中风护理质量通过早期中风护理过程中 11 项基于证据的指标的依从程度来定义。通过评估 7 天住院死亡率与个体患者符合的 QI 总数的比例之间的关联，研究整体遵循 QI 与结果之间的相关性。对年龄、性别、美国国立卫生研究院中风量表和生前遗嘱等变量进行广义线性混合模型分析，并作为医院的随机效应进行调整。
2015 年至 2016 年间，报告了 388012 例缺血性中风患者（中位数年龄 76 岁，52.4%为男性）。特定 QI 的依从率在 41.0%（符合溶栓条件的患者溶栓）和 95.2%（早期物理治疗）之间。7 天住院死亡率为 3.4%。整体 QI 符合率中位数为 90%（四分位距，75%-100%）。在多变量分析中，整体遵循 QI 与 7 天住院死亡率之间存在线性关联（依从率<50%与 100%相比，比值比 12.7 [95%CI，11.8-13.7]；<0.001）。
通过对早期中风治疗过程中一系列基于证据的流程 QI 的遵循程度来衡量更高的护理质量，与降低住院死亡率相关。
