Quality of Care and Mortality Among Patients With Stroke

BACKGROUND: The relationship between process and outcome measures among patients with stroke is unclear. OBJECTIVES: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. METHODS: Using data from The Danish National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific criteria: early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early examination with computed tomography/magnetic resonance imaging scan, and early assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Data on 30- and 90-day mortality rates were obtained through the Danish Civil Registration System. RESULTS: Six of 7 of these criteria were associated with lower 30- and 90-day mortality rates. Adjusted mortality rate ratios corrected for clustering by department ranged from 0.41 to 0.83. We found indication of an inverse dose-response relationship between the number of quality of care criteria met and mortality; the lowest mortality rate was found among patients whose care met all criteria compared with patients whose care failed to meet any criteria (ie, adjusted 30-day mortality rate ratios: 0.45, 95% confidence interval: 0.24-0.66). When analyses were stratified by age and sex, the dose-response relationship was found in all subgroups. CONCLUSIONS: Higher quality of care during the early phase of stroke was associated with substantially lower mortality rates.