Research to improve quality of stroke care is advancing but gaps exist

INDIANAPOLIS – Every 40 seconds, someone in the U.S. has a stroke. Every 3.5 minutes, someone in the U.S. dies of a stroke. Stroke patients have multifaceted needs, requiring complicated care delivered by multidisciplinary teams.

In the journal Stroke’s annual review of quality improvement advances in stroke care studies, Regenstrief Institute Research Scientist Dawn Bravata, M.D., and colleagues update researchers, clinicians and healthcare administrators on advances in the field, highlighting the challenges of scalability and sustainability.

“Quality improvement exists to ensure that every patient with stroke or at risk of stroke is getting the care that they are eligible to receive. Quality improvement activities can happen at a clinic level or hospital level or nationwide level,” says Dr. Bravata, a national leader in stroke care improvement, an internist who cares for stroke patients and a researcher with the U.S. Department of Veteran Affairs. “Stroke is a complex disease and stroke patients often require care by a variety of clinicians – neurologists, internists, nurses, pharmacists, physical therapists, rehab specialists and others. All can make contributions to quality improvement. Innovations that are multidimensional and multicomponent are often the ones that were successful in improving quality of care.”

Studies published in 2022 cover the continuum of care, from prehospitalization to acute care to rehabilitation settings. As in prior years, the overwhelming majority of quality improvement for stroke care research focused on the hyperacute (immediate post-stroke) period. Most studies continued to be from urban settings within developed nations with only one study of a rural population. Studies cover the spectrum from single hospital reports to regional and national care evaluations.

The review authors identify five gaps in stroke quality improvement research:

• studies are needed to describe quality improvement initiatives from rural healthcare settings, small facilities and underrepresented countries;
• segments of the continuum of care require attention, especially transitions of care, primary care and risk-factor management;
• studies on quality improvement for hemorrhagic stroke and transient ischemic attack are needed, as most studies focused on acute ischemic stroke;
• approaches to support scalability and sustainability of quality improvement initiatives should be evaluated; and
• de-implementation projects should be undertaken to reduce inappropriate care.

They also write that, from a policy evaluation perspective, comparison of stroke care quality across hospitals “before” versus “after” the public reporting of hospital performance data is critical to motivating quality improvement.

Authors of "Advances in Stroke: Quality Improvement" are Dawn M. Bravata, M.D.; Tara Purvis, MSci; Qinglan Pricilla Ding, PhD; Kimberly J. Waddell, PhD; and Monique F. Kilkenny, PhD. 

Author affiliations

Department of Veterans Affairs, Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.).

Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.).

Regenstrief Institute, Indianapolis, IN (D.M.B.).

Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences

at Monash Health, Monash University, Clayton, Victoria, Australia (T.P., M.F.K.).

The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia

(M.F.K.).

Purdue University School of Nursing, West Lafayette, IN (Q.P.D.).

VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center,

Philadelphia, PA (K.J.W.).

Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia (K.J.W.).

Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia

(K.J.W.).

Drs. Bravata and Kilkenny are section editors for quality improvement of the journal Stroke. This is the third consecutive year they have co-authored the journal’s review of studies on stroke quality improvement.

About Dawn Bravata, M.D.

In addition to her role as a research scientist at Regenstrief Institute, Dawn M. Bravata, M.D., is a professor of medicine and a professor of neurology at the Indiana University School of Medicine. She also serves as a core investigator for the U.S. Department of Veteran Affairs Health Services Research and Development Center for Health Information and Communication at Richard L. Roudebush VA Medical Center and is a co-principal investigator for VA HRS&D PRIS-M QUERI.

About Regenstrief Institute  

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe. 

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine  

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.