Benchmarks and determinants of adherence to stroke performance measures

Area of Science:

• Neurology
• Healthcare Quality Improvement
• Clinical Performance Measurement

Background:

• This study aimed to establish achievable benchmarks for nine acute stroke performance measures (PM) and identify organizational factors influencing adherence.
• A comprehensive analysis was conducted on 2,294 patients admitted with acute ischemic stroke across 17 hospitals to determine adherence rates and set benchmarks.
• Hospital characteristics and stroke-specific care processes were collected to evaluate their association with PM adherence.

Discussion:

• The findings indicate that high adherence levels are attainable for the majority of acute stroke PM, with benchmarks set at or above 90% for eight measures.
• Multilevel modeling revealed that the implementation of standing orders was the sole organizational factor significantly associated with adherence to multiple PM.
• This suggests that standardized protocols, particularly standing orders, play a crucial role in ensuring immediate and appropriate stroke care upon patient admission.

Key Insights:

• Benchmarks exceeding 90% are achievable for most acute stroke performance measures.
• The use of standing orders is strongly linked to adherence for critical PM, including dysphagia screening, venous thrombosis prophylaxis, tPA consideration, and patient education.
• Organizational factors, specifically standing orders, are critical drivers for improving stroke care quality.

Outlook:

• Future research should explore the widespread implementation and impact of standing orders on stroke care outcomes.
• Further investigation into optimizing hospital processes to enhance adherence to all stroke performance measures is warranted.
• These benchmarks and insights can guide quality improvement initiatives in stroke care settings.