FP7 Outputs
Published March 9, 2017 | Version v1
Journal article Open

Stroke unit care in germany: the german stroke registers study group (ADSR)

Creators

  • 1. Institute of Clinical Epidemiology and Biometry (ICE-B) Würzburg, Josef-Schneider-Str. 2 / D7, 97080, Würzburg, Germany
  • 2. Quality Assurance Project"Stroke Register Northwest Germany", Institute of Epidemiology and Social Medicine, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D3, 48149, Münster, Germany
  • 3. Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Rudower Straße 48, 12351, Berlin, Germany
  • 4. Office for Quality Assurance in Hospitals (GeQiK) Stuttgart at Baden-Wuerttembergische Hospital Federation, Stuttgart, Birkenwaldstr. 151, 70191, Stuttgart, Germany
  • 5. Vivantes Klinikum im Friedrichshain, Berlin, Landsberger Allee 49, 10249, Berlin, Germany
  • 6. Department of Neurology, Asklepios Klinik Nord, Hamburg,, Tangstedter Landstraße 400, 22417, Hamburg, Germany
  • 7. Institute of Quality Assurance Hesse (GQH), Frankfurter Str. 10, 65760, Eschborn, Germany
  • 8. Quality Assurance in Stroke Management in North Rhine–Westphalia, Medical Association North Rhine, Tersteegenstr. 9, 40474, Düsseldorf, Germany
  • 9. Institute of Quality Assurance Rhineland-Palatinate / SQMed, Wilhelm-Theodor-Römheld-Straße 34, 55130, Mainz, Germany
  • 10. Quality Association for Acute Stroke Treatment Schleswig-Holstein (QugSS), Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
  • 11. German Stroke Society, Berlin, Reinhardtstr. 27C, 10117, Berlin, Germany
  • 12. Bavarian Permanent Working Party for Quality Assurance, Munich, Westenriederstr. 19, 80331, Munich, Germany

Description

Background: Factors influencing access to stroke unit (SU) care and data on quality of SU care in Germany are scarce. We investigated characteristics of patients directly admitted to a SU as well as patient-related and structural factors influencing adherence to predefined indicators of quality of acute stroke care across hospitals providing SU care.

Methods: Data were derived from the German Stroke Registers Study Group (ADSR), a voluntary network of 9 regional registers for monitoring quality of acute stroke care in Germany. Multivariable logistic regression analyses were performed to investigate characteristics influencing direct admission to SU. Generalized Linear Mixed Models (GLMM) were used to estimate the influence of structural hospital characteristics (percentage of patients admitted to SU, year of SU-certification, and number of stroke and TIA patients treated per year) on adherence to predefined quality indicators.

Results: In 2012 180,887 patients were treated in 255 hospitals providing certified SU care participating within the ADSR were included in the analysis; of those 82.4% were directly admitted to a SU. Ischemic stroke patients without disturbances of consciousness (p < .0001), an interval onset to admission time ≤3 h (p < .0001), and weekend admission (p < .0001) were more likely to be directly admitted to a SU. A higher proportion of quality indicators within predefined target ranges were achieved in hospitals with a higher proportion of SU admission (p = 0.0002). Quality of stroke care could be maintained even if certification was several years ago.

Conclusions: Differences in demographical and clinical characteristics regarding the probability of SU admission were observed. The influence of structural characteristics on adherence to evidence-based quality indicators was low.

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Additional details

Funding

European Commission
EIS - Development of a European Implementation Score for measuring implementation of research into healthcare practice using vascular disease as an example 223153