TY  - JOUR
A1  - Wiedmann, Silke
A1  - Heuschmann, Peter U.
A1  - Hillmann, Steffi
A1  - Busse, Otto
A1  - Wiethoelter, Horst
A1  - Walter, Georg M.
A1  - Seidel, Guenter
A1  - Misselwitz, Bjoern
A1  - Janssen, Alfred
A1  - Berger, Klaus
A1  - Burmeister, Christoph
A1  - Matthias, Christine
A1  - Kolominsky-Rabas, Peter
A1  - Hermanek, Peter
T1  - The Quality of Acute Stroke Care-an Analysis of Evidence-Based Indicators in 260 000 Patients
JF  - Deutsches Ärzteblatt International
N2  - Background: Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date. Methods: The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects. Results: Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6%). Dysphagia screening was documented in 86.2% (range, 74.8-93.1%). For the following indicators, the defined targets were not reached for all of Germany: antiaggregation within 48 hours, 93.4% (range, 86.6-96.4%); anticoagulation for atrial fibrillation, 77.6% (range, 72.4-80.1%); standardized dysphagia screening, 86.2% (range, 74.8-93.1%); oral and written information of the patients or their relatives, 86.1% (range, 75.4-91.5%). The rate of patients examined or treated by a speech therapist was in the target range. Conclusion: The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.
KW  - Hesse
KW  - study-group ADSR
KW  - ischemic-stroke
KW  - Germany
KW  - implementation
KW  - rehabilitation
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-114747
SN  - 1866-0452
VL  - 111
IS  - 45
ER  - 
TY  - JOUR
A1  - Hillmann, Steffi
A1  - Wiedmann, Silke
A1  - Rücker, Viktoria
A1  - Berger, Klaus
A1  - Nabavi, Darius
A1  - Bruder, Ingo
A1  - Koennecke, Hans-Christian
A1  - Seidel, Günter
A1  - Misselwitz, Björn
A1  - Janssen, Alfred
A1  - Burmeister, Christoph
A1  - Matthis, Christine
A1  - Busse, Otto
A1  - Hermanek, Peter
A1  - Heuschmann, Peter Ulrich
T1  - Stroke unit care in Germany: the German stroke registers study group (ADSR)
JF  - BMC Neurology
N2  - 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.
KW  - stroke register
KW  - stroke unit care
KW  - quality of health care
KW  - quality indicators
Y1  - 2017
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-159447
VL  - 17
IS  - 49
ER  -