Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Acute Ischemic Stroke
Measuring Quality of Care for Ischemic Stroke Treated With Acute Reperfusion Therapy in Japan ― The Close The Gap-Stroke ―
Nice RenAtaru NishimuraAi KurogiKunihiro NishimuraRyu MatsuoKuniaki OgasawaraYoichiro HashimotoTakahiro HigashiNobuyuki SakaiKazunori ToyodaYoshiaki ShiokawaTeiji TominagaShigeru MiyachiAkiko KadaKeisuke AbeKotaro OnoKazunori MatsumizuKoichi ArimuraTakanari KitazonoSusumu MiyamotoKazuo MinematsuKoji Iihara
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Supplementary material

2021 Volume 85 Issue 2 Pages 201-209


Background:In Japan there is no consensus on how to efficiently measure quality indicators (QIs), defined as a standard of care, for acute ischemic stroke (AIS). Using information from a health insurance claims database and electronic medical records, we evaluated the feasibility and validity of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) or endovascular therapy (EVT).

Methods and Results:AIS patients receiving rt-PA or EVT between 2013 and 2015 were identified. We selected 17 AIS QI measures for primary stroke centers (PSCs) and 8 for comprehensive stroke centers (CSCs). Defined QIs were calculated for each hospital and then averaged. In total, the data of 8,206 patients (rt-PA 83.7%, EVT 34.9%) from 172 hospitals were obtained. Median National Institute of Health Stroke Scale score at admission was 14, and 37.7% of the patients were functionally independent at discharge. All target QIs were successfully measured with fewer missing values, and the accuracy of preset data was about 90%. Adherence rates were low (<50%) in 5 QI measures among PSCs, including door-to-needle time ≤1 h, and in 1 QI measure among CSCs (door-to-brain and vascular imaging time ≤30 min).

Conclusions:Measuring QIs for AIS by this novel approach was feasible and reliable in the provision of a national benchmark.

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