Abstract
INTRODUCTION:The evaluation of the quality of care for Stroke is a priority for health systems, given its relationship with disability and death. In this study, Stroke quality markers are analyzed in stroke in a referral hospital in Narino, Colombia.
OBJECTIVE:To evaluate the markers of quality of care in stroke in the Hospital Departamental Universitario de Narino E.S.E between June 2018 and December 2019. As a reference, the outcomes were compared with the Colombian registries on RES-Q platform.
MATERIALS AND METHODS:A retrospective descriptive study of patients treated in-hospital with stroke, data collection was performed using the RES-Q platform. The analysis was carried out using descriptive statistics and absolute and relative frequencies and the differences with analytical tests.
RESULTS:457patients were evaluated, with ischemic stroke predominance, endovenous thrombolysis was performed in 7.2 % in 2018, and 9.2 % in 2019, 27.7 % of patients had door to needle time less than 60 minutes in 2018 and 42.8 % in 2019. Among the quality markers evaluated, an improvement was found in the performance of NIHSS, dysphagia evaluation, and carotid doppler performance in ischemic stroke. Compared with Colombian registry, a lower percentage was found in endovenous thrombolysis and thrombectomy. Most of Stroke Care Markers are similar to national average.
CONCLUSIONS:The improvement in compliance of standard of Stroke Care Quality Markers reflects the impact of stroke care programs. The monitoring of quality parameters allows the generation of comprehensivestroke care programs in the region.
References
Norrving B, Bray BD, Asplund K, Heuschmann P, LanghorneP, Rudd AG, et al. Cross-national key performance measuresof the quality of acute stroke care in Western Europe. Stroke. 2015;46(10):2891-5.
GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol.2019;18(5):439-58.
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-528.
Lindsay P, Furie KL, Davis SM, Donnan GA, Norrving B. World Stroke Organization global stroke services guidelines and action plan. Int J Stroke. 2014;9(Suppl A100):4-13.
Brainin M, Olsen TS, Chamorro A, Diener HC, Ferro J, Hennerici MG, et al. Organization of stroke care: education, referral, emergency management and imaging, stroke units and rehabilitation. Cerebrovasc Dis. 2004;17(Suppl. 2):1-14.
Schwamm LH, Fonarow GC, Reeves MJ, Pan W, Frankel MR, Smith EE, et al. Get with the guidelines-stroke is associated with sustained improvement in care for patients hospitalized with acute stroke or transient ischemic attack. Circulation. 2009;119(1):107-15.
Navarro Soler IM, Ignacio García E, Masjuan Vallejo J, Gallego Culleré J, Mira Solves JJ. A set of care quality indicators for stroke management. Neurol Barc Spain. 2019;34(8):497-502.
Norrving B, Barrick J, Davalos A, Dichgans M, Cordonnier C, Guekht A, et al. Action Plan for Stroke in Europe 2018-2030. Eur Stroke J. 2018;3(4):309-36.
Adeoye O, Nystróm KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, et al. Recommendations for the establishment of stroke systems of care: a 2019 update. Stroke. 2019;50(7):e187-210.
Langhorne P, Ramachandra S; Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020;4(4):CD000197.
Man S, Cox M, Patel P, Smith EE, Reeves MJ, Saver JL, et al. Differences in acute ischemic stroke quality of care and outcomes by primary stroke center certification organization. Stroke. 2017;48(2):412-9.
Te Ao BJ, Brown PM, Feigin VL, Anderson CS. Are stroke units cost effective? Evidence from a New Zealand stroke incidence and population-based study. Int J Stroke Off J Int Stroke Soc. 2012;7(8):623-30.
Wang Y, Li Z, Zhao X, Liu L, Wang C, Wang C, et al. Evidencebased performance measures and outcomes in patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2018;11(12):e001968.
Organización Panamericana de la Salud (OPS). Módulo de principios de epidemiología para el control de enfermedades (MOPECE). Washington: OPS; 2002.
IHME. GBD compare data visualization. Institute for Health Metrics and Evaluation. 2016. Disponible en https://vizhub.healthdata.org/gbd-compare/
Khatib R, Jawaada AM, Arevalo YA, Hamed HK, Mohammed SH, Huffman MD. Implementing evidence-based practices foracute stroke care in low-and middle-income countries. Curr Atheroscler Rep. 2017;19(12):61.
Bayona-Ortiz H, Useche JN, Yanez N, Velasco SC. Availabilityof stroke units in Colombia. Lancet Neurol. 2019;18(11):988.
Reeves M, Lisabeth L, Williams L, Katzan I, Kapral M, Deutsch A, et al. Patient-reported outcome measures (PROMs) for acute stroke: rationale, methods and future directions. Stroke. 2018;49(6):1549-56.
Katzan IL, Thompson NR, Lapin B, Uchino K. Added value of patient-reported outcome measures in stroke clinical practice. J Am Heart Assoc. 2017;6(7):e005356.
Nilanont Y, Nidhinandana S, Suwanwela NC, Hanchaiphiboolkul S, Pimpak T, Tatsanavivat P, et al. Quality of acute ischemicstroke care in Thailand: a prospective multicenter country wide cohort study. J Stroke Cerebrovasc Dis. 2014;23(2):213-9.
Castañeda-Cardona C, Coral-Casas J, Rueda MC, Díaz-Cortés D, Ruiz A. Experiencia de trombólisis intravenosa en el manejo del ataque cerebro vascular en el Hospital Universitario San Ignacio 2011-2013 (EXTRO HUSI). Acta Neurol Colomb. 2014;30(1):16-21.
Guerrero-Gonzalez LF, Serna JJ, Gamez DX. Experiencia de trombólosis intravenosa en infarto cerebral agudo en un hospital universitario de Cali. Acta Med Colomb. 2014;39(2, Supl.1):46.
Coronel Gaviria A, Chilito PA, Cabrera Velasco CE, Zamora Bastidas T, Vargas Uricoechea H. Trombólisis endovenosa en ACV isquémico: experiencia en un hospital de Popayán, Cauca. Acta Neurol Colomb. 2020;36(1):11-7.
Mouthon-Reignier C, Bonnaud I, Gaudron M, Vannier-BernardS, Bodin JF, Cottier JP, De Toffol B, Debiais S. Impact of a direct-admission stroke pathway on delays of admission, care, and rates of intravenous thrombolysis. Rev Neurol (Paris). 2016;172(12):756-60.
McElwaine P, McCormack J, Brennan C, Coetzee H, Cotter P, Doyle R, et al. Thrombolysis for stroke in Ireland: increasing access and maintaining safety in a challenging environment. Ir J Med Sci. 2018;187(2):275-80.
Bandettini di Poggio M, Finocchi C, Brizzo F, Altomonte F, Bovis F, Mavilio N, et al. Management of acute ischemic stroke, thrombolysis rate, and predictors of clinical outcome. Neurol Sci. 2019;40(2):319-26.
Moreno E, Rodríguez J, Bayona-Ortiz H. Intravenous thrombolysis as treatment of acute ischemic stroke in Colombia: a systematic review of literature. Acta Neurol Colomb. 2019;35(3):156-66.
Martínez-Villota VA, Portillo Miño JD. Trombólisis intravenosa para ataque cerebrovascular isquémico en un hospitalde referencia en Nariño - Colombia. Acta Neurol Colomb. 2021;37(4):189-96.

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