Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

Lange, Marcos C; Braga, Gabriel Pereira; Nóvak, Edison M; Harger, Rodrigo; Felippe, Maria Justina Dalla Bernardina; Canever, Mariana; Dall’Asta, Isabella; Rauen, Jordana; Bazan, Rodrigo; Zetola, Viviane

doi:10.1590/0004-282X20170051

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ARTICLE • Arq. Neuro-Psiquiatr. 75 (6) • June 2017 • https://doi.org/10.1590/0004-282X20170051 copy

Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

Indicadores de performance de AVC do Ministério da Saúde do Brasil: avaliação comparativa e parametrização dos indicadores

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The present study aimed to analyze the stroke units in two centers for the key performance indicators (KPIs) required by the Ministry of Health in Brazil.

Methods

All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism.

Results

Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was < 13%, the hospital mortality for stroke was < 15%, and the hospital discharge on antithrombotic therapy was > 70%.

Conclusion

Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

stroke; quality indicators, health care; delivery healthcare; outcome and process assessment; health care

KPI	Definition	Method	Numerator	Denominator	Important points
Venous thromboembolism (VTE) prophylaxis in the first 48 hours after admission	Percentage of patients prescribed VTE prophylaxis on hospital days 0 or 1	Based on prospective data from patient medical records	Patients with ischemic stroke prescribed VTE prophylaxis in the first 48 hours after admission or those who have documentation related to why VTE prophylaxis was not provided	All patients with ischemic stroke	Prophylaxis: medications (heparin, low-molecular-weight heparin) or intermittent pneumatic compression. Reasons not to introduce: the patient was ambulatory or undergoing full-dose anticoagulation for other reasons
Hospital discharge on antithrombotic therapy (ATT) in patients without cardioembolic (CE) mechanisms	Percentage of patients without CE mechanisms discharged on ATT	Based on prospective data from patient medical records	Patients with ischemic stroke without CE mechanisms discharged on ATT	All patients with ischemic stroke without CE mechanisms	Antiaggregation or anticoagulation medication in therapeutic dosage considered
Hospital discharge on anticoagulation therapy in patients with atrial fibrillation or flutter	Percentage of patients with atrial fibrillation or flutter discharged on anticoagulation	Based on prospective data from patient medical records	Patients with ischemic stroke with atrial fibrillation or flutter discharged on anticoagulation	All patients with ischemic stroke with atrial fibrillation or flutter	Anticoagulation medication in therapeutic dosage considered
The ATT at the end of day 2	Percentage of patients with ischemic stroke on ATT at the end of day 2	Based on prospective data from patient medical records	Patients with ischemic stroke who are prescribed ATT at the end of day 2	All patients with ischemic stroke	Antiaggregant or anticoagulation medication in therapeutic dosage considered
Hospital discharge on statin therapy in patients with atherothrombotic mechanisms	Percentage of patients with atherothrombotic mechanisms discharged on statins	Based on prospective data from patient medical records	Patients with ischemic stroke with atherothrombotic mechanisms discharged on statins	All patients with ischemic stroke with atherothrombotic mechanisms	At least 50% stenosis to considered atherothrombotic mechanisms
Hospital discharge on rehabilitation and secondary prevention therapy in patients with ischemic stroke	Percentage of patients with ischemic stroke discharged on rehabilitation and secondary prevention therapy	Based on prospective data from patient medical records	Patients with ischemic stroke discharged on rehabilitation and secondary prevention therapy	All patients with ischemic stroke	Documented in the patient’s file
Percentage of patients admitted to the stroke unit	Percentage of patients with stroke admitted to the Stroke Unit	Based on prospective data from patient medical records	Patients with stroke admitted to the stroke unit	All patients with stroke	Registered in the hospital’s central data
Mean time (in days) of hospital stay for patients with stroke	Mean time (in days) of hospital stay for patients with stroke	Based on prospective data from patient medical records	Mean time (in days) of hospital stay for patients with stroke	NA
Deep venous thrombosis (DVT)	Percentage of patients with ischemic stroke with DVT at admission	Based on prospective data from patient medical records	Patients with ischemic stroke with DVT at admission	All patients with ischemic stroke	Clinical diagnosis or supported by complementary tests
Pressure ulcer (PU)	Percentage of patients with ischemic stroke with PU at admission	Based on prospective data from patient medical records	Patients with ischemic stroke with PU at admission	All patients with ischemic stroke	Clinical diagnosis or supported by complementary tests
Pneumonia	Percentage of patients with ischemic stroke with pneumonia at admission	Based on prospective data from patient medical records	Patients with ischemic stroke with pneumonia at admission	All patients with ischemic stroke	Clinical diagnosis or supported by complementary tests
Urinary tract infection (UTI)	Percentage of patients with ischemic stroke with UTI at admission	Based on prospective data from patient medical records	Patients with ischemic stroke with UTI at admission	All patients with ischemic stroke	Clinical diagnosis or supported by complementary tests
Specific ICD-10 to stroke etiology at discharge	Percentage of patients discharged with stroke admitted to the stroke unit with the specific ICD-10 to stroke etiology	Based on prospective data from patient medical records	Percentage of patients discharged with stroke admitted to the stroke unit with the specific ICD-10 to stroke etiology	All patients with stroke admitted to the SU	ICD-10 I64 was not considered appropriate
Hospital mortality due to stroke	Percentage of patients with stroke who died during hospital admission	Based on prospective data from patient medical records	Percentage of patients with stroke who died during hospital admission	All patients with stroke admitted to the hospital
Door-to-image time <25 minutes	Percentage of patients with ischemic stroke submitted to brain CT in less than 25 minutes of admission	Based on prospective data from patient medical records	Percentage of patients with ischemic stroke submitted to brain CT in less than 25 minutes of admission	All patients with ischemic stroke admitted to the hospital within less than 24 hours of symptoms onset
Door-to-needle time <60 minutes	Percentage of patients with ischemic stroke submitted to thrombolysis in less than 60 minutes of admission	Based on prospective data from patient medical records	Percentage of patients with ischemic stroke submitted to thrombolysis in less than 60 minutes of admission	All patients with ischemic stroke submitted to thrombolysis and admitted to the hospital

Variable	SPSU	FUPR

	(%)	(%)
DTI	27	83
DTN	75	66
DVT prophylaxis on day 2	92	88
Antiplatelet therapy on day 2	97	94
Antiplatelet therapy at discharge in non-cardioembolic IS	75	100
Anticoagulation therapy at discharge in cardioembolic (atrial fibrillation) IS	94	87
Statin at discharge in atherothrombotic IS	100	88
Plan of rehabilitation and prophylaxis at discharge	96	87
Percentage of stroke patients admitted to the stroke unit	94	84
DVT	0.6	0.0
Pneumonia	13	6
UTI	11	6
PU	0.6	1
Mortality rate	8	14
Specific ICD-10 to stroke etiology at discharge	24	64

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[1] Correspondence: Marcos C Lange; Hospital de Clínicas, Serviço de Neurologia; Rua General Carneiro, 181 / 4º andar; 80060-900 Curitiba PR, Brasil; E-mail: langeneuro@gmail.com