Stroke rehabilitation quality indicators: raising the bar in the inpatient rehabilitation facility

Even though quality indicators are becoming more common in clinical medicine, there are very few of them in the area of stroke rehabilitation. This article proposes quality indicators for stroke rehabilitation based upon the Donabedian triad of structure, process, and outcomes. The quality indicators are in 3 categories: service delivery; system care coordination; and stroke prevention, health promotion, and medical management. Specific areas of focus include organized care, intensity of service, transitions of care, secondary stroke prevention, hypertension, diabetes mellitus, coronary artery disease, hyperlipidemia, deep venous thrombosis prophylaxis, pneumonia and influenza vaccines, and patient and professional education. By highlighting both the presence and absence of evidence in various aspects of stroke rehabilitation, clinicians and researchers can focus on quality improvement in areas that already are known while providing opportunities for research into areas that evidence does not yet support.