Benchmarks for Acute Stroke Care Delivery
Benchmarks for Acute Stroke Care Delivery
Objective Despite widespread interest in many jurisdictions in monitoring and improving the quality of stroke care delivery, benchmarks for most stroke performance indicators have not been established. The objective of this study was to develop data-derived benchmarks for acute stroke quality indicators.
Design Nine key acute stroke quality indicators were selected from the Canadian Stroke Best Practice Performance Measures Manual.
Participants A population-based retrospective sample of patients discharged from 142 hospitals in Ontario, Canada, between 1 April 2008 and 31 March 2009 (N = 3191) was used to calculate hospital rates of performance and benchmarks.
Intervention The Achievable Benchmark of Care (ABC™) methodology was used to create benchmarks based on the performance of the upper 15% of patients in the top-performing hospitals.
Main Outcome Measures Benchmarks were calculated for rates of neuroimaging, carotid imaging, stroke unit admission, dysphasia screening and administration of stroke-related medications.
Results The following benchmarks were derived: neuroimaging within 24 h, 98%; admission to a stroke unit, 77%; thrombolysis among patients arriving within 2.5 h, 59%; carotid imaging, 93%; dysphagia screening, 88%; antithrombotic therapy, 98%; anticoagulation for atrial fibrillation, 94%; antihypertensive therapy, 92% and lipid-lowering therapy, 77%. ABC™ acute stroke care benchmarks achieve or exceed the consensus-based targets required by Accreditation Canada, with the exception of dysphagia screening.
Conclusions Benchmarks for nine hospital-based acute stroke care quality indicators have been established. These can be used in the development of standards for quality improvement initiatives.
Benchmarking has gained popularity as a health care quality performance measurement tool with benchmarks used to compare delivery of care across institutions and jurisdictions and to encourage excellent performance by ranking institutions and highlighting top performers. Establishing realistic performance benchmarks that monitor implementation of evidence-based best practice has been shown to improve performance compared with audit and feedback alone.
Benchmarks based on subjective or expert panel consensus rather than empirical data may be viewed as invalid. Data-derived benchmarks based on the average or median by definition are unlikely to drive excellence. The Achievable Benchmarks of Care (ABC™) approach is a method to establish 'real world' performance benchmarks by examining performance across all relevant organizations or health care providers and then determining the best care achieved by at least 10% of the eligible patients across organizations to identify 'top' performance levels. This method produces benchmarks that can be seen as realistic targets, as they have been achieved by at least one provider caring for at least 10% of all eligible patients in the sample.
Currently, there is limited information on appropriate benchmarks for acute stroke care delivery. In Ontario, a regionally based system of stroke care delivery—the Ontario Stroke System—was established in 2000. Within this system, regional stroke centers are accountable for leading the implementation of stroke care best practices across a geographic region, which includes a number of community hospitals, rehabilitation facilities (inpatient and ambulatory), community-based providers, community support agencies, health promotion practitioners, long-term care facilities and pre-hospital care providers. The regional stroke centers are typically large teaching or academic hospitals with neurology and neurosurgical services, sophisticated diagnostic technologies and annual stroke/transient ischemic attack (TIA) volumes ranging from 400 to >1100 per year. The established and organized approach to stroke care within Ontario provides a unique opportunity to develop and use stroke benchmarks for quality improvement.
Abstract and Introduction
Abstract
Objective Despite widespread interest in many jurisdictions in monitoring and improving the quality of stroke care delivery, benchmarks for most stroke performance indicators have not been established. The objective of this study was to develop data-derived benchmarks for acute stroke quality indicators.
Design Nine key acute stroke quality indicators were selected from the Canadian Stroke Best Practice Performance Measures Manual.
Participants A population-based retrospective sample of patients discharged from 142 hospitals in Ontario, Canada, between 1 April 2008 and 31 March 2009 (N = 3191) was used to calculate hospital rates of performance and benchmarks.
Intervention The Achievable Benchmark of Care (ABC™) methodology was used to create benchmarks based on the performance of the upper 15% of patients in the top-performing hospitals.
Main Outcome Measures Benchmarks were calculated for rates of neuroimaging, carotid imaging, stroke unit admission, dysphasia screening and administration of stroke-related medications.
Results The following benchmarks were derived: neuroimaging within 24 h, 98%; admission to a stroke unit, 77%; thrombolysis among patients arriving within 2.5 h, 59%; carotid imaging, 93%; dysphagia screening, 88%; antithrombotic therapy, 98%; anticoagulation for atrial fibrillation, 94%; antihypertensive therapy, 92% and lipid-lowering therapy, 77%. ABC™ acute stroke care benchmarks achieve or exceed the consensus-based targets required by Accreditation Canada, with the exception of dysphagia screening.
Conclusions Benchmarks for nine hospital-based acute stroke care quality indicators have been established. These can be used in the development of standards for quality improvement initiatives.
Introduction
Benchmarking has gained popularity as a health care quality performance measurement tool with benchmarks used to compare delivery of care across institutions and jurisdictions and to encourage excellent performance by ranking institutions and highlighting top performers. Establishing realistic performance benchmarks that monitor implementation of evidence-based best practice has been shown to improve performance compared with audit and feedback alone.
Benchmarks based on subjective or expert panel consensus rather than empirical data may be viewed as invalid. Data-derived benchmarks based on the average or median by definition are unlikely to drive excellence. The Achievable Benchmarks of Care (ABC™) approach is a method to establish 'real world' performance benchmarks by examining performance across all relevant organizations or health care providers and then determining the best care achieved by at least 10% of the eligible patients across organizations to identify 'top' performance levels. This method produces benchmarks that can be seen as realistic targets, as they have been achieved by at least one provider caring for at least 10% of all eligible patients in the sample.
Currently, there is limited information on appropriate benchmarks for acute stroke care delivery. In Ontario, a regionally based system of stroke care delivery—the Ontario Stroke System—was established in 2000. Within this system, regional stroke centers are accountable for leading the implementation of stroke care best practices across a geographic region, which includes a number of community hospitals, rehabilitation facilities (inpatient and ambulatory), community-based providers, community support agencies, health promotion practitioners, long-term care facilities and pre-hospital care providers. The regional stroke centers are typically large teaching or academic hospitals with neurology and neurosurgical services, sophisticated diagnostic technologies and annual stroke/transient ischemic attack (TIA) volumes ranging from 400 to >1100 per year. The established and organized approach to stroke care within Ontario provides a unique opportunity to develop and use stroke benchmarks for quality improvement.
