Background: Guideline-recommended care processes are increasingly being used to measure hospital quality of stroke care. However, data regarding the association between hospital process performance and outcomes are limited. We use the China National Stroke Registry (CNSR) to examine how hospital performance measures are correlated with each other and identify whether hospital’s overall composite guideline adherence was associated with risk standardized adjusted 30-days and 1-year mortality after stroke.
Methods: We assessed hospital individual nine performance metrics as well as overall composite adherence rates using 2007-2008 data from 131 hospitals participating in the CNSR and correlated these measures with each other and with hospital-level, risk-standardized, 30 day and 1-year mortality rates.
Results: We found moderately correlations (correlation coefficients≥0.40, P values<0.001) between antithrombotic use at discharge and admission, lipid-lowering drug, antihypertensive medication, antidiabetic medication, smoking cessation at discharge, antihypertensive medication and antidiabetic medication at discharge, smoking cessation and antidiabetic medication at discharge. Composite guideline adherence rate was modestly associated with hospital-level, risk-standardized, 30 day and 1-year mortality rates (correlation coefficients=0.23 and 0.34; P values<0.01), explained only 5.24% and 11.80% of hospital-level variation in risk-standardized, 30 day and 1-year mortality rates for patients with acute ischemic stroke.
Conclusion: There were various correlations in guideline-recommended hospital performance among the individual process metrics. A modestly strong association between care process and hospital short- and long-term risk-adjusted mortality rates was found, indicating the use of more broader, guideline-based performance metrics as a means of assessing hospital quality.