Advances in improving quality in stroke care

Every 40 seconds, someone in the United States has a stroke. Every 3.5 minutes someone in the United States dies from a stroke. Stroke patients have multifaceted needs, requiring complex care delivered by multidisciplinary teams.

in the journal ApoplexyAnnual review of progress in improving quality in stroke care studies, Regenstrief Institute research scientist Dawn Bravata and colleagues update researchers, clinicians, and healthcare administrators on developments in the field, highlighting the challenges of scalability and sustainability.

“Quality improvement exists to ensure that every patient who has had a stroke or is at risk of having a stroke receives the care they are eligible to receive. Quality improvement activities can occur at the clinic, hospital or country level,says Dr. Pravata, a national leader in improving stroke care, an internist who cares for stroke patients and a researcher with the US Department of Veterans Affairs.Stroke is a complex disease and stroke patients often require care from a variety of doctors – neurologists, internists, nurses, pharmacists, physiotherapists, rehabilitation specialists, and more. Everyone can contribute to improving quality. It is often the multidimensional and multicomponent innovations that have successfully improved the quality of care. “

Studies published in 2022 cover the continuum of care, from hospital admissions to acute care to rehabilitation facilities. As in previous years, the vast majority of quality improvement for stroke care research has focused on the hyperacute period (immediately after stroke). Most studies continued to be from urban settings within developed countries with only one study of a rural population. The studies cover the range from individual hospital reports to regional and national assessments of care.

The review authors identified five gaps in research to improve stroke quality:

• Studies are needed to describe quality improvement initiatives from rural healthcare settings, small facilities and underrepresented countries;
• Parts of the continuum of care require attention, particularly care transitions, primary care and risk factor management;
• Studies on improving the quality of hemorrhagic stroke and transient ischemic attack are needed, as most studies focused on acute stroke;
• The support approach should be assessed for the scalability and sustainability of quality improvement initiatives; And
• Cancellation projects should be implemented to reduce inappropriate care.

They also write that, from a policy evaluation perspective, comparing the quality of stroke care across hospitals ‘before’ versus ‘after’ public reporting of hospital performance data is critical to incentivizing quality improvement.