[Identification of quality indicators of stroke care]

The purpose of the present study was to identify existing quality indicators of stroke care and to select those that are appropriate for use in the German health care system.

A systematic literature search in databases of performance measures, clinical indicator programs, stroke guidelines and published scientific literature (published in 1993-2002) identified 151 quality indicators. This number was reduced by selecting indicators that satisfied the following quality criteria for clinical performance measures: a) consensus on the relative importance of aspects of clinical care (according to the American Heart Association/American College of Cardiology Forum), b) controllability of aspects of clinical care (according to the German "Advisory Council for the Concerted Action in Health Care") and c) internal validity (according to the stroke guideline of the Royal College of Physicians, UK).

Of the 151 quality indicators, 31 fulfilled all three criteria for clinical performance measures. After elimination of overlapping indicators 13 quality indicators remained covering important aspects of the quality of stroke care in Germany: two of these indicators refer to the quality of structural aspects of care, six consider processes of care and five indicators are devoted to outcomes of care. These 13 indicators cover "prevention, rehabilitation, coordination and continuity of care", which are important controllable aspects of care. Whereas six indicators were considered to be highly valid, seven indicators did not convey enough information to ensure their validity.

Suitable quality indicators covering several important aspects of stroke care could be selected from existing indicators for the development of an appropriate set of indicators to be used in the German health care system.