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Neuro rehab research

“Quality of stroke care is advancing but gaps exist”



In its latest annual review of quality improvement advances in stroke care studies, the journal Stroke highlights updates in the field.

The review authors include Regenstrief Institute Research Scientist Dawn Bravata, M.D., and colleagues highlight updates in the field.

Dr Bravata, says: “Quality improvement exists to ensure that every patient with stroke or at risk of stroke is getting the care that they are eligible to receive. Quality improvement activities can happen at a clinic level or hospital level or nationwide level.

“Stroke is a complex disease and stroke patients often require care by a variety of clinicians – neurologists, internists, nurses, pharmacists, physical therapists, rehab specialists and others. All can make contributions to quality improvement. Innovations that are multidimensional and multicomponent are often the ones that were successful in improving quality of care.”

Studies published throughout 2022 cover the continuum of care, ranging from pre-hospitalisation to acute care to rehabilitation settings. As in years prior, the overwhelming majority of quality improvement for stroke care research focused on the hyperacute (immediate post-stroke) period.

Most studies continued the theme of being from urban settings within developed nations with only one study of a rural population. Studies cover the spectrum from single hospital reports to regional and national care evaluations.

The review authors identified what they consider to be five gaps in stroke quality improvement research:

  1. Studies are needed to describe quality improvement initiatives from rural healthcare settings, small facilities and underrepresented countries.
  2. Segments of the continuum of care require attention, especially transitions of care, primary care and risk-factor management.
  3. Studies on quality improvement for haemorrhagic stroke and transient ischaemic attack are needed, as most studies focused on acute ischaemic stroke.
  4. Approaches to support scalability and sustainability of quality improvement initiatives should be evaluated.
  5. De-implementation projects should be undertaken to reduce inappropriate care.

They also note that, from a policy evaluation perspective, comparison of stroke care quality across hospitals “before” versus “after” the public reporting of hospital performance data is critical to motivating quality improvement.