Quality improvement advances in stroke care

Every 40 seconds someone in the United States has a stroke. Every 3.5 minutes someone in the United States dies of a stroke. Stroke patients have multiple needs, requiring complex care delivered by multidisciplinary teams.

In the review StrokeIn her annual review of advances in quality improvement in stroke care studies, Regenstrief Institute researcher Dawn Bravata, MD, and her colleagues inform researchers, clinicians and administrators of healthcare advances in the field, highlighting the challenges of scalability and sustainability.

“Quality improvement exists to ensure that every patient with stroke or at risk of stroke receives the care for which they are eligible. Quality improvement activities can take place at the clinic or hospital level or at the national level,“says Dr. Bravata, a national leader in improving stroke care, an internist who cares for stroke patients, and a researcher with the U.S. Department of Veterans Affairs.”Stroke is a complex disease and stroke patients often require care by a variety of clinicians – neurologists, internists, nurses, pharmacists, physiotherapists, rehabilitation specialists and others. All can contribute to quality improvement. Multi-dimensional and multi-component innovations are often the ones that have succeeded in improving the quality of care.”

Studies published in 2022 cover the continuum of care, from pre-hospitalization to acute care and rehabilitation settings. As in previous years, the overwhelming majority of quality improvement in stroke care research has focused on the peracute (immediate post-stroke) period. Most studies have continued to come from urban settings in developed countries with only one study from a rural population. The studies run the gamut from individual hospital reports to regional and national assessments of care.

The review authors identify five gaps in stroke quality improvement research:

• studies are needed to describe quality improvement initiatives in rural health care settings, small facilities, and underrepresented countries;
• segments of the continuum of care require special attention, particularly care transitions, primary care and risk factor management;
• studies on improving the quality of hemorrhagic stroke and transient ischemic attacks are needed, as most studies have focused on acute ischemic stroke;
• approaches to support the scalability and sustainability of quality improvement initiatives should be evaluated; And
• de-implementation projects should be undertaken to reduce inappropriate care.

They also write that, from a policy evaluation perspective, comparing the quality of stroke care between hospitals “before” versus “after” public reporting of hospital performance data is essential to drive quality improvement.