Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

Lange, Marcos Christiano; Braga, Gabriel Pereira; Nóvak, Edison Matos; Harger, Rodrigo; Felippe, Maria Justina Dalla Bernardina; Canever, Mariana; Dall’Asta, Isabella; Rauen, Jordana; Bazan, Rodrigo; Zétola, Viviane Flumignan

doi:10.1590/0004-282x20170051

Cited by 13 publications

(24 citation statements)

References 19 publications

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“…One of the most significant measures introduced in the clinical practice to improve the outcome and to reduce costs and hospital stay was the stroke unit 11-12 : a specific ward where the quality measures can be monitored continually 13 . A previous study demonstrated the impact of those findings in two distinct comprehensive stroke units 14 , showing the value of an organized specialized center, with the nurse team predominantly looking for a better care.…”

Section: Introductionmentioning

confidence: 75%

Preditores de internação prolongada em Unidade de Acidente Vascular Cerebral (AVC)

Gaspari

Cruz

Batista³

et al. 2019

Rev. Latino-Am. Enfermagem

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Objective to analyze the in-hospital complications of prolonged hospital stay in patients with ischemic stroke or transient ischemic attack, admitted to the stroke unit of a tertiary hospital.Method this is an evaluative correlational study. All first-ever ischemic stroke or transient ischemic attack patients admitted were retrospectively analyzed. During hospital stay, the predictors of long-term hospitalization considered were: 1) clinical complications (pneumonia, urinary tract infection, pressure damage and deep vein thrombosis), and 2) neurological complications (malignant ischemic stroke and symptomatic hemorrhagic transformation).Results 353 patients were discharged in the study period. Mean age was 64.1±13.7 years old and 186 (52.6%) were men. The mean time of hospital stay was 13.7±14.3 days. Pneumonia (25.3±28.8 days, p<0.001), urinary tract infection (32.9±45.2 days, p<0.001) and malignant stroke (29.1±21.4 days, p<0.001) increased significantly the length of hospital stay compared to patients without any complications (11.2±7.1 days).Conclusion this study showed that three complications delayed hospital discharge in patients admitted in a stroke unit, two preventable ones: pneumonia and urinary tract infection. More intense measures to avoid them should be included in the performance indicators to reduce the length of hospital stay in stroke units.

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Section: Introductionmentioning

confidence: 75%

Preditores de internação prolongada em Unidade de Acidente Vascular Cerebral (AVC)

Gaspari

Cruz

Batista³

et al. 2019

Rev. Latino-Am. Enfermagem

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“…e-ASPECTS has demonstrated a good correlation compared to assessments by neuroradiologists, stroke neurologists, and residents in neurology, but current analyses have been performed only in high-income countries. In low-and middle-income countries, the use of this software may improve time-totreatment, which is still far less than ideal 6,9 .…”

Section: Introductionmentioning

confidence: 99%

The use of e-ASPECTS in acute stroke care: validation of method performance compared to the performance of specialists

Ferreti

Leitão

Teixeira

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation. Objective: To determine the ability of e-ASPECTS in differentiating images with and without injury. Methods: One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury. Results: e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively. Conclusion: e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.

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“…12 More recently, an analysis of patients admitted to 2 public hospitals in the South and Southeast region in 2015 showed an 85% rate of antiplatelet therapy at discharge, 91% of anticoagulation therapy in cardioembolic strokes, and 95% of statins prescription at discharge in atherothrombotic strokes. 13 These results were not much different from the results of a private hospital in the same region that had 100% rate of antithrombotic medication, 86.7% of anticoagulation in patients with cardioembolic strokes due to atrial fibrillation, and 56.1% of lipid lowering with a target of ≤100mg/dl. 14 Some additional challenges for secondary stroke prevention in Brazil are income inequality, aging of the population, higher rates of cardiovascular risk factors in the young and CD, known to be related to higher mortality and recurrence risks.…”

Section: Secondary Preventionmentioning

confidence: 63%

Stroke Care Services in Brazil

Silva

Rocha

Pontes-Neto

et al. 2018

Journal of Stroke Medicine

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The burden of stroke in Brazil, as in other developing countries, has considerably increased over the past years. With incidence rates ranging from 105 to 137 cases per 100 000 persons per year and mortality reaching 24%, stroke is a major public health issue in this continental country. Although most strokes in Brazil can be attributed to classic treatable cardiovascular risk factors, infectious diseases such as Chagas disease, arboviruses hemorrhagic fevers, neurocysticercosis, and malaria are also important risk factors. Socioeconomic disparities and population unawareness about stroke symptoms are great challenges in Brazil. There was an improvement in stroke awareness after the Brazilian Stroke Society and the World Stroke Organization launched several campaigns throughout the country. Another important step was taken in 2012, when the Brazilian Ministry of Health published the Brazilian National Stroke Act, including reimbursement for rtPA, creation of stroke centers qualified according to the hospital complexity, integration of the Brazilian Emergency Medical System, establishment of a budget for the rehabilitation system, and education and training of healthcare professionals and of the population. Since these measures, the number of stroke centers increased from 35 in 2008 to 149 in 2017 and stroke mortality in public stroke centers decreased from 17.9% in 2010 to 12.8% in 2014. Although much has improved, Brazil still has major social inequalities and further measures are needed to guarantee a high-quality stroke care.

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Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

Abstract: Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

Cited by 13 publications

References 19 publications

Preditores de internação prolongada em Unidade de Acidente Vascular Cerebral (AVC)

Preditores de internação prolongada em Unidade de Acidente Vascular Cerebral (AVC)

The use of e-ASPECTS in acute stroke care: validation of method performance compared to the performance of specialists

Stroke Care Services in Brazil

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