Quality metrics in the management of acute stroke in Greece during the first 5 years of Registry of Stroke Care Quality (RES-Q) implementation

Abstract

Introduction: Establishment of a prospective stroke registry may promote the documentation and improvement of acute stroke care. We present the status of stroke management in Greece using the Registry of Stroke Care Quality (RES-Q) dataset. Methods: Consecutive patients with acute stroke were prospectively registered in RES-Q registry by contributing sites in Greece during the years 2017–2021. Demographic and baseline characteristics, acute management, and clinical outcomes at discharge were recorded. Stroke quality metrics, with a specific interest in the association between acute reperfusion therapies and functional recovery in ischemic stroke patients are presented. Results: A total of 3590 acute stroke patients were treated in 20 Greek sites (61% men, median age 64 years; median baseline NIHSS 4; 74% ischemic stroke). Acute reperfusion therapies were administered in almost 20% of acute ischemic stroke patients, with a door to needle and door to groin puncture times of 40 and 64 min, respectively. After adjustment for contributing sites, the rates of acute reperfusion therapies were higher during the time epoch 2020–2021 compared to 2017–2019 (adjusted OR 1.31; 95% CI 1.04–1.64; p < 0.022; Cochran-Mantel-Haenszel test). After propensity-score-matching, acute reperfusion therapies administration was independently associated with higher odds of reduced disability (one point reduction across all mRS scores) at hospital discharge (common OR 1.93; 95% CI 1.45–2.58; p < 0.001). Conclusions: Implementation and maintenance of a nationwide stroke registry in Greece may guide the stroke management planning, so that prompt patient transportation, acute reperfusion therapies, and stroke unit hospitalization become more widely accessible, improving the functional outcomes of stroke patients.

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

“…Therefore, we graphically present data about DNT and dysphagia screening (Figures 1 and 2), refraining from comparisons between hospitals. This source of bias has also been reported in RES-Q-based analyses of stroke care in Greece and Estonia [17,18]. It is vital to recognise that the performance metrics used in high quality registries like the RES-Q are formulated based on expert consensus and scholarly agreement [12,31].…”

“…These measures formed the foundation for the development of the international Registry of Stroke Care Quality (RES-Q) [13]. The RES-Q has gained increasing global recognition as a free-to-use tool for identifying gaps in hospital processes and facilitating their subsequent optimisation [14][15][16][17][18][19]. For reasons of feasibility, the RES-Q in its original version consciously refrained from capturing detailed information about clinical outcomes, especially the long-term functional outcomes.…”

Quality Metrics in Acute Stroke: Time to Own

“… 12 Prompt patient transportation, acute reperfusion therapies, and stroke unit hospitalization were found more widely accessible in Greece, and these parameters helped in improving the functional outcomes of stroke patients. 13 In the USA, the implementation of quality metrics based on 11–100 parameters decreased hospital mortality leading to better outcomes. 14 What is evident from the literature is that several methodological difficulties, make the interpretation of data from various sources, quite challenging.…”