Vol 58, No 1 (2024)
Research Paper
Published online: 2023-12-01

open access

Page views 635
Article views/downloads 662
Get Citation

Connect on Social Media

Connect on Social Media

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Michał Karliński1, Adam Kobayashi2, Maciej Niewada3, Waldemar Fryze4, Agata Tomczak5, Waldemar Brola6, Konrad Rejdak7, Piotr Luchowski7, Bożena Adamkiewicz8, Małgorzata Wiszniewska9, Urszula Włodarczyk9, Radosław Kaźmierski10, Pawel Kram11, Halina Bartosik-Psujek12, Rafał Kaczorowski12, Piotr Sobolewski13, Małgorzata Fudala14, Agata Gałązka15, Marcin Rogoziewicz16, Anna Rogoziewicz16, Halina Sienkiewicz-Jarosz17, Ewelina Cybulska17, Natalia Pożarowszczyk1, Jacek Staszewski18, Aleksander Dębiec18, Ewa Horoch-Łyszczarek19, Alicja Mączkowiak20, Anna Czlonkowska1
Pubmed: 38037889
Neurol Neurochir Pol 2024;58(1):75-83.

Abstract

Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year.

Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually.

Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable.

Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

Article available in PDF format

View PDF Download PDF file

References

  1. Ding Q, Liu S, Yao Y, et al. Global, Regional, and National Burden of Ischemic Stroke, 1990-2019. Neurology. 2022; 98(3): e279–e290.
  2. Polish National Health Fund report NFZ o zdrowiu, udar niedokrwienny mozgu. 2019. https://ezdrowie.gov.pl/portal/home/badania-i-dane/zdrowe-dane/raporty/nfz-o-zdrowiu-udar-niedokrwienny-mozgu (17.09.2023).
  3. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; 6(1): I–LXII.
  4. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019; 50(12): e344–e418.
  5. Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, et al. Wytyczne postępowania w udarze mózgu. Polski Przegląd Neurologiczny. 2019; 15(A): 1–156.
  6. Mikulik R, Bar M, Cernik D, et al. Stroke 20 20: Implementation goals for intravenous thrombolysis. Eur Stroke J. 2021; 6(2): 151–159.
  7. Karliński M, Kobayashi A, Karaszewski B, et al. Designing the future of thrombectomy in Poland: first we must agree on the principles. Postepy Kardiol Interwencyjnej. 2022; 18(1): 1–3.
  8. Karliński M, Kozera-Strzelińska D, Sienkiewicz-Jarosz H, et al. Reliability of prehospital diagnosis of acute cerebrovascular accident. Neurol Neurochir Pol. 2022; 56(1): 89–95.
  9. Norrving Bo, Barrick J, Davalos A, et al. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J. 2018; 3(4): 309–336.
  10. Angels Initiative. https://Eso-Stroke.Org/Projects/Angels/ (17.09.2023).
  11. Subcommittee Task Force on Stroke Registries. Feasibility and value of stroke registries for regional medical programs. Public Health Reports. 1968; 83: 537–550.
  12. Smith EE, Saver JL, Alexander DN, et al. Clinical performance measures for adults hospitalized with acute ischemic stroke. Stroke. 2014; 45(11): 3472–3498.
  13. Mikulík R, Caso V, Bornstein NM, et al. Enhancing and accelerating stroke treatment in eastern european region: methods and achievement of the ESO EAST program. Eur Stroke J. 2020; 5(2): 204–212.
  14. Członkowska A, Karliński M, Niewada M. The Polish RES-Q Collaborative Group. The quality of acute stroke care in Poland: preliminary findings from the RES-Q registry. European Stroke J. 2018; 3(IS): 290.
  15. Medina-Rioja R, González-Calderón G, Saldívar-Dávila S, et al. Grace under pressure: resiliency of quality monitoring of stroke care during the covid-19 pandemic in mexico city. Front Neurol. 2022; 13: 831735.
  16. Tiu C, Terecoasă EO, Tuță S, et al. Quality of acute stroke care in Romania: Achievements and gaps between 2017 and 2022. Eur Stroke J. 2023; 8(1 Suppl): 44–51.
  17. Palaiodimou L, Kargiotis O, Katsanos AH, et al. Quality metrics in the management of acute stroke in Greece during the first 5 years of Registry of Stroke Care Quality (RES-Q) implementation. Eur Stroke J. 2023; 8(1 Suppl): 5–15.
  18. Kõrv J, Antsov K, Gross-Paju K, et al. Developments in quality of stroke care in Estonia. Eur Stroke J. 2023; 8(1 Suppl): 35–43.
  19. Yeghiazaryan N, Isahakyan A, Zubalova L, et al. Stroke care in Armenia: Recent developments. Eur Stroke J. 2023; 8(1 Suppl): 28–34.
  20. Eldh AC, Wallin L, Fredriksson M, et al. Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open. 2016; 6(11): e011562.
  21. Mensah GA, Sacco RL, Vickrey BG, et al. From data to action: neuroepidemiology informs implementation research for global stroke prevention and treatment. Neuroepidemiology. 2015; 45(3): 221–229.
  22. Dempsey K, Ferguson C, Walczak A, et al. Australian Health Research Alliance (AHRA) Health System Improvement and Sustainability Working Group members. Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review. Syst Rev. 2022; 11(1): 237.
  23. Registry of Stroke Care Quality, RES-Q. https://qualityregistry.eu (17.09.2023).
  24. Zdrowe Dane. https://ezdrowie.gov.pl/portal/home/badania-i-dane/zdrowe-dane/zestawienia (17.09.2023).
  25. Karlinski MA, Bembenek JP, Baranowska A, et al. Infections diagnosed after admission to a stroke unit and their impact on hospital mortality in Poland from 1995 to 2015. J Stroke Cerebrovasc Dis. 2018; 27(7): 1775–1782.
  26. Wiszniewska M, Sankowska M. Stroke in the COVID-19 pandemic era. Postep Psychiatr Neurol. 2022; 31(2): 69–73.
  27. Marto JP, Strambo D, Ntaios G, et al. Global COVID-19 Stroke Registry. Safety and outcome of revascularization treatment in patients with acute ischemic stroke and COVID-19: the global COVID-19 stroke registry. Neurology. 2023; 100(7): e739–e750.
  28. Nogueira RG, Qureshi MM, Abdalkader M, et al. SVIN COVID-19 Global Stroke Registry, SVIN COVID-19 Global Stroke Registry. Global impact of COVID-19 on stroke care and IV thrombolysis. Neurology. 2021; 96(23): e2824–e2838.
  29. Nguyen TN, Qureshi MM, Klein P, et al. and the SVIN COVID-19 Global Stroke Registry. Global impact of the COVID-19 pandemic on stroke volumes and cerebrovascular events: a 1-year follow-up. Neurology. 2023; 100(4): e408–e421.
  30. Dębiec A, Bilik M, Piasecki P, et al. Effect of COVID-19 pandemic on stroke admissions and quality of stroke interventional treatment in Masovian Voivodeship. Neurol Neurochir Pol. 2021; 55(2): 223–226.
  31. Yu AYX, Bravata DM, Norrving Bo, et al. Measuring stroke quality: methodological considerations in selecting, defining, and analyzing quality measures. Stroke. 2022; 53(10): 3214–3221.



Neurologia i Neurochirurgia Polska