DOI: https://doi.org/10.22141/2224-0713.16.1.2020.197325

Assessment of the quality of inpatient stroke care delivery according to the data of RES-Q

T.S. Mishchenko, N.M. Chemer, S.P. Moskovko, A.P. Huk, O.D. Shulha, Yu.V. Flomin, M.V. Huliaieva, T.M. Muratova, D.M. Khramtsov, Yu.S. Vadziuk

Abstract


Background. The REgistry of Stroke Care Quality (RES-Q) enables to evaluate the quality of care provided to the stroke patients in hospitals and to compare it with the quality in other countries. Objective: to evaluate the quality of inpatient care for patients with stroke in Ukraine. Materials and methods. Since 2017, information about 14,305 patients from 90 hospitals in Ukraine has been entered in the RES-Q. Results. The average age of patients was 68 years. 85.08 % of persons had ischemic stroke, 10.53 % — intracerebral hemorrhage, 1.98 % — subarachnoid hemorrhage, 0.01 % — venous thrombosis, 0.27 % — cryptogenic stroke, 2.13 % — transient ischemic attack. In 19.33 % of patients, cerebral stroke was recurrent. Results. 67.9 % of patients were treated in stroke units, the rest — in intensive care units, wards of general neurology and neurosurgery. Computed tomography, magnetic resonance imaging were performed in 92.1 % of patients. National Institutes of Health Stroke Scale was used to assess the severity of stroke in 88.5 % of individuals (mean score — 9). The dysphagia test was performed in 86.71 % of patients. Recanalization was carried out in 5.94 % of persons with ischemic stroke (thrombolytic therapy — 5.33 %, mechanical thrombectomy — 0.61 %). 0.29 % of patients underwent hemicraniectomy. Removal of intracranial hematoma was performed in 2.7 % of persons with intracerebral hemorrhages. 71.98 % of patients received rehabilitation care. Conclusions. Completing the RES-Q allowed us to assess the quality of treatment on a small number of patients (5 % of the total number of stroke patients for 3 years in Ukraine) and to admit that it required a significant improvement and changes in the care organization.

Keywords


cerebral stroke; RES-Q; quality of treatment; neuroimaging; thrombolytic therapy; stroke units; secondary prevention

References


Feigin V.L. Anthology of stroke epidemiology in the 20th and 21st centuries: Assessing the past, the present, and envisioning the future. International Journal of Stroke. 2019. № 14(3). Р. 223-237.

Feigin V.L., Roth G.A., Naghavi M. et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global burden of disease study 2013. Lancet Neurol. 2016. 15. 913-924.

Roth G.A., Johnson C., Abajobir A. et al. Global, Regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J. Am. Coll. Cardiol. 2017. 70. 1-25.

Romero J.R., Wolf P.A. Epidemiology of Stroke: le­gacy of the Framingham Heart Study. Glob. Heart. 2013. 8. 67-75.

Johnson W., Onuma O., Owolabi M., Sachdev S. Stroke: a global response is needed. Bull. World Health Organ. 2016. 94. 634-634a.

Norrving B., Barrick J., Davalos A. et al. Action Plan for stroke in Europe 2018–2030. Eur. Stroke J. 2018. 3. 309-336.

Feigin V., Norrving B., Sudlow C.L.M., Sacco R.L. Updated criteria for population-based stroke and transient ischemic attack incidence studies for the 21st century. Stroke. 2018. 49. 2248-2255.

Parke H.L., Epiphaniou E., Pearce G. et al. Self-management support interventions for stroke survivors: a systematic meta-review. PLoS One. 2015. 10. e0131448.

Schwamm L.H., Fonarow G.C., Reeves M.J., Pan W., Frankel M.R., Smith E.E., Ellrodt G., Cannon C.P., Liang L., Peterson E., Labresh K.A. Get with the Guidelines-Stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2009. 119. 107-115.

Piepoli M.F., Hoes A.W., Agewall S. et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur. Heart J. 2016. 37. 2315-2381.

Hillmann S., Wiedmann S., Fraser A. et al. Temporal changes in the quality of acute stroke care in five national audits across Europe. Biomed. Res. Int. 2015. 2015. 432497.

Watkins C.L., Leathley M.J., Jones S.P. et al. Training emergency services’ dispatchers to recognise stroke: an interrupted time-series analysis. BMC Health Serv. Res. 2013. 13. 318.

Fothergill R.T., Williams J., Edwards M.J. et al. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians? Stroke. 2013. 44. 3007-3012.

Ebinger M., Kunz A., Wendt M. et al. Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol. 2015. 72. 25-30.

Lahr M.M., Luijckx G.J., Vroomen P.C. et al. Proportion of patients treated with thrombolysis in a centralized versus a decentra-lized acute stroke care setting. Stroke. 2012. 43. 1336-1340.

Bray B.D., Ayis S., Campbell J. et al. Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study. BMJ. 2013. 346. f2827.

Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst. Rev. 2013. 9. CD000197.

Wardlaw J.M., Seymour J., Cairns J. et al. Immediate CT scanning of acute stroke is cost effective and improves quality of life. Stroke. 2004. 35. 2477-2483.

Fearon P., Langhorne P. Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients. Cochrane Database Syst. Rev. 2012. 9. CD000443.

Langhorne P., Baylan S. Early Supported Discharge Trialists. Early supported discharge services for people with acute stroke. Cochrane Database Syst. Rev. 2017. 7. CD000443.

Audebert H.J., Schultes K., Tietz V. et al. Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care (TEMPiS). Stroke. 2009. 40. 902-908.

Urimubenshi G., Langhorne P., Cadilhac D.A. et al. Association between patient outcomes and key performance indicators of stroke care quality: a systematic review and meta-analysis. Eur. Stroke. J. 2017. 2. 287-307.

Bray B.D., Cloud G.C., James M.A. et al. Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. Lancet. 2016. 388. 170-177.

Aguiar de Sousa D., von Martial R., Abilleira S. Access to and delivery of acute ischaemic stroke treatments: a survey of national scientific societies and stroke experts in 44 European countries. Eur. Stroke J. 2018. Epub. DOI: 10.1177/2396987318786023.

Lees K.R., Bluhmki E., von Kummer R. et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010. 375. 1695-1703.

Emberson J., Lees K.R., Lyden P. et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014. 384. 1929-1935.

Saver J.L., Goyal M., van der Lugt A. et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016. 316. 1279-1288.

Reinink H., de Jonge J.C., Bath P.M. et al. ­PRECIOUS: PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke. Rationale and design of a randomised, open, phase III, clinical trial with blinded outcome assessment. Eur. Stroke J. 2018. 3. 291-298.

Johnston S.C., Easton J.D., Farrant M. et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N. Engl. J. Med. 2018. 379. 215-225.

Berkhemer O.A., Fransen P.S., Beumer D. et al. A rando-mized trial of intraarterial treatment for acute ischemic stroke. N. Engl. J. Med. 2015. 372. 11-20.

Goyal M., Demchuk A.M., Menon B.K. et al. Randomized assessment of rapid endovascular treatment of ische­mic stroke. N. Engl. J. Med. 2015. 372. 1019-1030.

Saver J.L., Goyal M., Bonafe A. et al. Stent-retriever thromb-ectomy after intravenous t-PA vs. t-PA alone in stroke. N. Engl. J. Med. 2015. 372. 2285-2295.

Campbell B.C., Mitchell P.J., Kleinig T.J. et al. Endovascular therapy for ischemic stroke with perfusion-ima­ging selection. N. Engl. J. Med. 2015. 372. 1009-1018.

Jovin T.G., Chamorro A., Cobo E. et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N. Engl. J. Med. 2015. 372. 2296-2306.

Lawrence M., Pringle J., Kerr S. et al. Multimodal secondary prevention behavioral interventions for TIA and stroke: a systematic review and meta-analysis. PLoS One. 2015. 10. e0120902.

Lopez-Lopez J.A., Sterne J.A.C., Thom H.H.Z. et al. Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and costeffectiveness analysis. BMJ. 2017. 359. j5058.

Niu X., Ou-Yang G., Yan P.F. et al. Closure of patent foramen ovale for cryptogenic stroke patients: an updated systematic review and meta-analysis of randomized trials. J. Neurol. 2018. 265. 1259-1268.

World Health Organization. World Report on Disability 2011. Geneva: World Health Organization, 2011. Rehabilitation. www.ncbi.nlm.nih.gov/books/NBK304081/ (accessed 19 April 2018).

World Health Organization. Rehabilitation 2030: a call for action, www.who.int/disabilities/care/rehab-2030/en/ (2017, accessed 24 April 2018).

Forster A., Brown L., Smith J. et al. Information provision for stroke patients and their caregivers. Cochrane Database Syst. Rev. 2012. 11. CD001919.

Morris R. Meeting the psychological needs of community-living stroke patients and carers: a study of third sector provision. Disabil. Rehabil. 2016. 38. 52-61.




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