Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register

Söderholm, Anna; Stegmayr, Birgitta; Glader, Eva-Lotta; Asplund, Kjell

doi:10.1159/000444679

Cited by 38 publications

(32 citation statements)

References 17 publications

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“…The high coverage limits the risk of patient selection bias. Riksstroke is also subject to extensive and recurring internal validation of data, and there are no indications of any systematic differences in data quality between different hospitals . The high missings of NIHSS are not optimal, but RLS is suggested to be an acceptable proxy for stroke severity .…”

Section: Discussionmentioning

confidence: 99%

Diurnal variations in the quality of stroke care in Sweden

et al. 2019

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Time of admission affects the quality of care across a wide range of clinical presentations including acute stroke. [1][2][3][4][5][6][7][8][9][10][11] In particular, a recently published meta-analysis revealed increased short-term mortality and disability at discharge in stroke patients who had presented off-hours. 12 However, less is known about the underlying causes of these effects. 13,14 A recent study on general emergency admissions found that the magnitude of the weekend effect was significantly reduced when adjusting for patient comorbidity and common blood tests, suggesting that differences in patient characteristics contribute. 15Objectives: A recent study of acute stroke patients in England and Wales revealed several patterns of temporal variation in quality of care. We hypothesized that similar patterns would be present in Sweden and aimed to describe these patterns.Additionally, we aimed to investigate whether hospital type conferred resilience against temporal variation. Materials and Methods:We conducted this nationwide registry-based study using data from the Swedish Stroke Register (Riksstroke) including all adult patients registered with acute stroke between 2011 and 2015. Outcomes included process measures and survival. We modeled time of presentation as on/off-hours, shifts, day of week, 4-hour, and 12-hour time blocks. We studied hospital resilience by comparing outcomes across hospital types. Results:A total of 113 862 stroke events in 72 hospitals were included. The process indicators and survival all showed significant temporal variation. Door-to-needle (DTN) time within 30 minutes was less likely during nighttime than daytime (OR 0.50; 95% CI 0.41-0.60). Patients admitted during off-hours had lower odds of direct stroke unit (SU) admission (OR 0.72; 95% CI 0.70-0.75). 30-day survival was lower in nighttime vs daytime presentations (OR 0.90, 95% CI 0.84-0.96). The effects of temporal variation differed significantly between hospital types for DTN time within 30 minutes and direct SU admission where university hospitals were more resilient than specialized non-university hospitals. Conclusions:Our study shows that variation in quality of care and survival is present throughout the whole week. We also found that university hospitals were more resilient to temporal variation than specialized non-university hospitals. K E Y W O R D S off-hours, quality of care, stroke, temporal variation, weekend effect, weekly variation S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Darehed D, Blom M, Glader E-L, et al. Diurnal variations in the quality of stroke care in Sweden. Acta

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Section: Discussionmentioning

confidence: 99%

Diurnal variations in the quality of stroke care in Sweden

et al. 2019

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“…Given that all Swedish hospitals caring for stroke patients report data to Riksstroke, along with a coverage of approximately 95% of stroke cases, we assess the risk of selection bias as low (15, 17). Riksstroke also undergoes extensive internal data validation, with no indications of systematic differences in data quality between hospitals (25). The rate of missing data was also low; this, along with the prospective nature of data collection in Riksstroke, vouches for better data quality than that obtained by using sources that accumulate data as a by-product of routine care delivery (i.e., electronic health records).…”

Section: Discussionmentioning

confidence: 99%

Time Trends and Monthly Variation in Swedish Acute Stroke Care

et al. 2019

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Background and Purpose: Studies of monthly variation in acute stroke care have led to conflicting results. Our objective was to study monthly variation and longitudinal trends in quality of care and patient survival following acute stroke.Methods: Our nationwide study included all adult patients (≥18 years) with acute stroke (ischemic or hemorrhagic), admitted to Swedish hospitals from 2011 to 2016, and that were registered in The Swedish Stroke Register (Riksstroke). We studied how month of admission and longitudinal trends affected acute stroke care and survival. We also studied resilience to this variation among hospitals with different levels of specialization.Results: We included 132,744 stroke admissions. The 90-day survival was highest in May and lowest in January (84.1 vs. 81.5%). Thrombolysis rates and door-to-needle time within 30 min increased from 2011 to 2016 (respectively, 7.3 vs. 12.8% and 7.7 vs. 28.7%). Admission to a stroke unit as first destination of hospital care was lowest in January and highest in June (78.3 vs. 80.5%). Stroke unit admission rates decreased in university hospitals from 2011 to 2016 (83.4 vs. 73.9%), while no such trend were observed in less specialized hospitals. All the differences above remained significant (p < 0.05) after adjustment for possible confounding factors.Conclusion: We found that month of admission and longitudinal trends both affect quality of care and survival of stroke patients in Sweden, and that the effects differ between hospital types. The observed variation suggests an opportunity to improve stroke care in Sweden. Future studies ought to focus on identifying the specific factors driving this variation, for subsequent targeting by quality improvement efforts.

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“…The study population originated from Riksstroke, which also contributed stroke-related and demographical data, as well as the follow-up questionnaires. Riksstroke is a national quality registry that has a coverage rate of > 90% of all people having a stroke and being treated at a hospital in Sweden 16 , and includes all hospitals admitting acute stroke patients. Riksstroke has a 1-year follow-up questionnaire survey sent out by post to all surviving people in the registry, examining a variety of items concerning life after stroke.…”

Section: Data Collectionmentioning

confidence: 99%

Differences in self-perceived general health, pain, and depression 1 to 5 years post-stroke related to work status at 1 year

Westerlind

Persson

Palstam

et al. 2020

Sci Rep

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Stroke is one of the most common diseases and has several potential consequences, such as psychological problems and pain. Return to work (RTW) after stroke in working-age individuals is incomplete. The present study aimed to investigate differences in self-perceived general health, pain, and depression between 1 and 5 years post-stroke related to RTW status. The study was nationwide, registry-based and the study population (n = 398) consisted of working-age people who had a stroke in 2011 and participated in 1-year and 5-year follow-up questionnaire surveys. Shift analyses with the Wilcoxon signed rank test and logistic regression were used. RTW within the first year post-stroke was associated with better self-perceived general health, less pain, and less depression both at 1 and 5 years post-stroke, compared with the no-RTW group. However, the RTW group had significant deterioration in general health and pain between 1 and 5 years, while the no-RTW group had no significant change. RTW was a significant predictor of lower odds of improvement in general health and pain between 1 and 5 years. This emphasizes the need for continued follow-up and support to ensure a balance between work and health for RTW individuals after stroke. Globally, stroke is the second largest cause of death and the second most common cause of disability 1. Although the total incidence of stroke is decreasing in most parts of the world, the number of disability adjusted life years is increasing 1 , as is the incidence of stroke in the working age population (20-64 years old) 2. Consequences of stroke, in addition to physical and cognitive impairment, include depression 3 and pain 4. The prevalence varies, but it has been estimated that approximately 1 of 3 suffers from depression 3 and up to half of the people have pain post-stroke 4. Ten years post-stroke, pain and psychological problems are two of the symptoms still experienced by a substantial proportion of people with stroke 5. Hypothetical recovery trajectories after stroke show a fast recovery during the first weeks and plateaus after approximately 6 months. After the initial 6 months the patterns are heterogeneous, with some people declining and some continuing to improve 6. In line with this, improvements in activities of daily living the first year poststroke has been reported, but between 1 and 3 years post-stroke there seems to be a small decline 7. Participants in another study reported less self-efficacy, less optimism and less proactive coping 2 years post-stroke compared with 2 months post-stroke 8. A decline in several self-reported functional aspects such as strength, activities of daily living, and mobility between 1 and 6 years post-stroke has also been reported 9. Absence from work due to sickness could have an effect on the individual's life situation as a whole. In addition to its impact on the financial situation, being on long-term sick leave is detrimental to psychological well-being and sleep 10 , and is even a risk factor for developing stroke 11. Working seems to...

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Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register

Cited by 38 publications

References 17 publications

Diurnal variations in the quality of stroke care in Sweden

Diurnal variations in the quality of stroke care in Sweden

Time Trends and Monthly Variation in Swedish Acute Stroke Care

Differences in self-perceived general health, pain, and depression 1 to 5 years post-stroke related to work status at 1 year

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