Elsevier

Neurologic Clinics

Volume 26, Issue 4, November 2008, Pages 1191-1207
Neurologic Clinics

National and International Quality Initiatives to Improve Stroke Care

https://doi.org/10.1016/j.ncl.2008.06.002Get rights and content

Stroke, the second leading cause of death throughout the world, has a major impact on society. This article provides a summary of quality improvement initiatives, including those relating to hospitals, the system of care delivery infrastructure, and legislative efforts in the United States and in various countries outside of the United States. Through quality improvement initiatives, it is projected that stroke outcomes may improve and the economic burden of stroke may be reduced.

Section snippets

Prevention initiatives

The United States CDCP sponsors several prevention initiatives designed to improve stroke health. These include Healthy People 2010 and the Paul Coverdell Stroke Registry. Healthy People 2010 is a national prevention statement of health objectives designed to identify the most significant preventable threats to health and to establish national goals to reduce these threats. Overall goals of Healthy People 2010 are to increase the quality and years of healthy life and to eliminate disparities in

Emergency medical service initiatives

In the United States, telephone activation of emergency medical services (EMS) using “911” increases the likelihood that an acute stroke patient will present to the emergency department early enough to be evaluated for acute thrombolytic treatment [6]. Multiple quality initiatives directed at educating potential users of the 911 system have been conducted by the National Stroke Association, the American Stroke Association, and the National Institute of Neurologic Disorders and Stroke. To

Initial quality improvement

Initial hospital initiatives to improve stroke care were developed for various reasons, including improving fiscal outcomes, creating meaningful evidence-based medicine pertaining to stroke quality, improving overall care. Beginning in the 1970s and 1980s, published articles on stroke quality initiatives began with the focus on stroke rehabilitation program outcomes and development of neurovascular care units, stroke centers, and stroke intensive care units [8], [9], [10], [11], [12], [13]. In

Rehabilitation initiatives

In 2004, the Rehabilitation and Recovery Advisory (RRAB) of the National Stroke Association began to strategically investigate how rehabilitation services could be enhanced so providers who wanted to specialize in stroke rehabilitation could be recognized as leaders in stroke recovery and rehabilitation services. The Commission on Accreditation of Rehabilitation Facilities (CARF) is an international third party accreditation system that currently accredits approximately 5,000 organizations that

Stroke system development and legislation

Quality improvement initiatives reach beyond a single hospital. System-wide approaches have been advocated. For example, in Mississippi this began with a novel statewide approach to care delivery with emphasis on providing various levels of stroke care. In February 2000, the Mississippi Stroke Education Consortium (MSEC), a state-based volunteer advocacy group dedicated to decrease the impact of stroke in Mississippi through continuous education, published a state-based template to promote

International stroke initiatives

Quality stroke initiatives are increasing among countries around the world, in part because of medical tourism. After the successful launch of domestic DSC primary stroke center certification, Joint Commission International (JCI) began a process of certifying hospitals that met international standards. Approximately 2 years after the launch of their domestic program, the JCI, a division of Joint Commission Resources, the not-for-profit affiliate of The Joint Commission, began development of

Summary

Major strides have been made to improve quality of stroke care. The development of stroke units and care pathways has led to improvements in the organization of stroke care. In parallel, there has been the establishment of PSCs and state level programs to improve stroke care. In the future, we may be formally certifying comprehensive stroke centers [49]. Furthermore, the use of quality tools borrowed from other industries may better identify areas for quality improvement in stroke. Finally, as

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