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External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland
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Affiliations- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Pharmacology and Clinical Pharmacology, Institute of Medical Sciences, Faculty of Medicine - Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
- Department of Neurology, Copernicus Hospital, Gdansk, Poland
- Neurology and Stroke Department, St. Wincenty a Paulo Hospital, Gdynia, Poland
- Collegium Medicum, Jan Kochanowski University, Kielce, and Department of Neurology, Specialist Hospital, Konskie, Poland
- Department of Neurology, Medical University of Lublin, Lublin, Poland
- Comprehensive Cancer Center and Traumatology, Copernicus Memorial Hospital in Lodz, Poland
- Stanisław Staszic Specialist Hospital, Neurology with Stroke Unit in Piła, Poland
- Department of Neurology, Collegium Medicum, University of Zielona Góra, and Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Neurology with Stroke Unit, 1st Clinical Hospital, Pomeranian Medical University, Szczecin, and Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
- Faculty of Medicine, University of Rzeszow, Rzeszow, Poland
- Collegium Mecicum, Jan Kochanowski University, Kielce and Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Poland
- Neurology Department with Stroke Unit, Skarżysko-Kamienna Hospital, Skarżysko-Kamienna, Poland
- Department of Neurology, Specialist Hospital in Sucha Beskidzka, Poland
- Department of Neurology with Stroke Unit; Nicolaus Copernicus Specialist Municipal Hospital in Torun; at the time of data collection - Department of Neurology with Stroke Unit; 107th Military Hospital with Polyclinic in Wałcz, Poland
- 1st Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Clinic of Neurology, Military Institute of Medicine, Warsaw, Poland
- Department of Neurology, T. Marciniak Lower Silesian Specialist Hospital, Wroclaw, Poland
- Department of Neurology and Stroke, Pomeranian Hospitals, Wejherowo, Poland
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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.
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.
Keywords
acute stroke, quality monitoring, stroke care management, outcome, registry, Poland
About this articleTitle
External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
75-83
Published online
2023-12-01
Page views
547
Article views/downloads
580
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2024;58(1):75-83.
Keywords
acute stroke
quality monitoring
stroke care management
outcome
registry
Poland
Authors
Michał Karliński
Adam Kobayashi
Maciej Niewada
Waldemar Fryze
Agata Tomczak
Waldemar Brola
Konrad Rejdak
Piotr Luchowski
Bożena Adamkiewicz
Małgorzata Wiszniewska
Urszula Włodarczyk
Radosław Kaźmierski
Pawel Kram
Halina Bartosik-Psujek
Rafał Kaczorowski
Piotr Sobolewski
Małgorzata Fudala
Agata Gałązka
Marcin Rogoziewicz
Anna Rogoziewicz
Halina Sienkiewicz-Jarosz
Ewelina Cybulska
Natalia Pożarowszczyk
Jacek Staszewski
Aleksander Dębiec
Ewa Horoch-Łyszczarek
Alicja Mączkowiak
Anna Czlonkowska
References (31)- Ding Q, Liu S, Yao Y, et al. Global, Regional, and National Burden of Ischemic Stroke, 1990-2019. Neurology. 2022; 98(3): e279–e290.
- 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).
- 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.
- 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.
- Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, et al. Wytyczne postępowania w udarze mózgu. Polski Przegląd Neurologiczny. 2019; 15(A): 1–156.
- Mikulik R, Bar M, Cernik D, et al. Stroke 20 20: Implementation goals for intravenous thrombolysis. Eur Stroke J. 2021; 6(2): 151–159.
- 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.
- 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.
- Norrving Bo, Barrick J, Davalos A, et al. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J. 2018; 3(4): 309–336.
- Angels Initiative. https://Eso-Stroke.Org/Projects/Angels/ (17.09.2023).
- Subcommittee Task Force on Stroke Registries. Feasibility and value of stroke registries for regional medical programs. Public Health Reports. 1968; 83: 537–550.
- Smith EE, Saver JL, Alexander DN, et al. Clinical performance measures for adults hospitalized with acute ischemic stroke. Stroke. 2014; 45(11): 3472–3498.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Yeghiazaryan N, Isahakyan A, Zubalova L, et al. Stroke care in Armenia: Recent developments. Eur Stroke J. 2023; 8(1 Suppl): 28–34.
- 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.
- 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.
- 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.
- Registry of Stroke Care Quality, RES-Q. https://qualityregistry.eu (17.09.2023).
- Zdrowe Dane. https://ezdrowie.gov.pl/portal/home/badania-i-dane/zdrowe-dane/zestawienia (17.09.2023).
- 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.
- Wiszniewska M, Sankowska M. Stroke in the COVID-19 pandemic era. Postep Psychiatr Neurol. 2022; 31(2): 69–73.
- 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.
- 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.
- 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.
- 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.
- 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.
