Relationship between process and outcome in stroke care

Background and Purpose-Better processes in stroke care are assumed to lead to better stroke outcomes. We sought to test whether current measures of stroke process are related to measures of stroke outcome. Methods-This was a prospective study of consecutive patients with acute stroke admitted to each of the 3 general hospitals in I region who were followed up for 12 months after hospital discharge. Process was measured by use of the Royal College of Physicians Stroke Audit Package, and outcomes were measured with a range of disability, health status, handicap, and independence measures, as well as mortality. Results-One hundred eighty-one patients were recruited. There was evidence for a relationship between some process variables and outcomes at hospital discharge, but the relationships were generally weak. None of the process variables remained in regression models of functional outcomes at 12 months. The hospital with the best process scores had the worst case mix-adjusted outcomes. Conclusions-The link between stroke process and outcome, through the use of currently available measures of process such as the Royal College of Physicians Stroke Audit Package, is not straightforward. Ongoing work may clarify some of these issues and provide guidance to stroke clinicians on how best to improve existing services.