Skip to main content

Advertisement

SpringerLink
Log in

Can online benchmarking increase rates of thrombolysis? Data from the Austrian stroke unit registry

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Despite its widespread availability and known safety and efficacy, a therapy with intravenous thrombolysis is still undergiven. We aimed to identify whether nationwide quality projects—like the stroke registry in Austria—as well as online benchmarking and predefined target values can increase rates of thrombolysis. Therefore, we assessed 6,394 out of 48,462 patients with ischemic stroke from the Austrian stroke registry (study period from March 2003 to December 2011) who had undergone thrombolysis treatment. We defined lower level and target values as quality parameters and evaluated whether or not these parameters could be achieved in the past years. We were able to show that rates of thrombolysis in Austria increased from 4.9 % in 2003 to 18.3 % in 2011. In a multivariate regression model, the main impact seen was the increase over the years [the OR ranges from 0.47 (95 % CI 0.32–0.68) in 2003 to 2.51 (95 % CI 2.20–2.87) in 2011). The predefined lower and target levels of thrombolysis were achieved at the majority of participating centers: in 2011 the lower value of 5 % was achieved at all stroke units, and the target value of 15 % was observed at 21 of 34 stroke units. We conclude that online benchmarking and the concept of defining target values as a tool for nationwide acute stroke care appeared to result in an increase in the rate of thrombolysis over the last few years while the variability between the stroke units has not yet been reduced.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Stroke Unit Trialists′Collaboration (1997) Collaborative systematic review of the randomized trials of organized inpatient (stroke unit) care after stroke. BMJ 314(7088):1151–1159

    Article  Google Scholar 

  2. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333:1581–1587

    Article  Google Scholar 

  3. Ferrari J, Knoflach M, Kiechl S, Willeit J, Schnabl S, Seyfang L, Lang W, For the Austrian Stroke Unit Registry Collaborators (2010) Early clinical worsening in patients with TIA or minor stroke: the Austrian stroke unit registry. Neurology 74:136–141

    Article  PubMed  CAS  Google Scholar 

  4. R Development Core Team (2010) R: a language and environment for statistical computing. R Foundation dor Statistical Computing, Vienna, ISBN 3-900051-07-0, URL http://www.R-project.org

  5. Ringelstein EB, Chamorro A, Kaste M, Langhorne P, Leys D, Lyrer P, Thijs V, Thomassen L, Toni D, ESO Stroke Unit Certification Committee (2013) European stroke organisation recommendations to establish a stroke unit and stroke center. Stroke 44(3):828–840

    Article  PubMed  Google Scholar 

  6. Leys D, Ringelstein EB, Kaste M, Hacke W, For the European Stroke Initiative (EUSI) Executive Committee (2007) Facilities available in European hospitals treating stroke patients. Stroke 38:2985–2991

    Article  PubMed  Google Scholar 

  7. Leys D, Ringelstein EB, Kaste M, Hacke W, For the European Stroke Initiative (EUSI) Executive Committee (2007) The main components of stroke unit care: results of a European expert survey. Cerebrovasc Dis 23(5–6):344–352

    Article  PubMed  Google Scholar 

  8. Ringelstein EB, Meckes-Ferber S, Hacke W, Kaste M, Brainin M, Leys D, For the European Stroke Initiative (EUSI) Executive Committee (2009) European stroke facilities survey: the German and Austrian perspective. Cerebrovasc Dis 27:138–145

    Article  PubMed  Google Scholar 

  9. Dirks M, Niessen LW, van Wijngaarden JDH, Koudstaal PJ, Franke CL, van Osterbrugge RJ, Huijsman R, Lingsma HF, Minkman MM, Dippel DW, For the PRomoting ACute Thrombolysis in Ischemic StrokE (PRACTISE) Investigators (2011) Promoting thrombolysis in acute ischemic stroke. Stroke 42:1325–1330

    Article  PubMed  CAS  Google Scholar 

  10. Engelter ST, Bonati LH, Lyrer PA (2006) Intravenous thrombolysis in stroke patients of > or =80 versus <80 years of age—a systematic review across cohort studies. Age Ageing 35(6):572–580

    Article  PubMed  Google Scholar 

  11. Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, Innes K, Venables G, Czlonkowska A, Kobayashi A, Ricci S, Murray V, Berge E, Slot KB, Hankey GJ, Correia M, Peeters A, Matz K, Lyrer P, Gubitz G, Phillips SJ, Arauz A, IST-3 collaborative group (2012) The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379(9834):2352–2363

    Article  PubMed  Google Scholar 

  12. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, ECASS Investigators (2008) Thrombolysis with alteplase 3–4.5 h after acute ischemic stroke. N Engl J Med 359:1317–1329

    Article  PubMed  CAS  Google Scholar 

  13. Merino JG, Silver B, Wong E, Foell B, Demaerschalk B, Tamayo A, Poncha F, Hachinski V, Southwestern Ontario Stroke Program (2002) Extending tissue plasminogen activator use to community and rural stroke patients. Stroke 33(1):141–146

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

The authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Neurology, Hospital Barmherzige Brueder, Grosse Mohren Gasse 9, 1020, Vienna, Austria

    Julia Ferrari & Wilfried Lang

  2. Danube University Krems, Gesundheit Österreich GmbH/BIQG, Stubenring 6, 1010, Vienna, Austria

    Leonhard Seyfang

Authors
  1. Julia Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leonhard Seyfang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wilfried Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julia Ferrari.

Additional information

For the Austrian Stroke Unit Registry Collaborators.

Austrian stroke unit registry collaborators

Austrian stroke unit registry collaborators

Eugen Trinka, MD (Christian-Doppler-Klinik, Salzburg, local site investigator); Johannes Sebastian Mutzenbach, MD (Christian- Doppler-Klinik, Salzburg,local site investigator); Christoph Sulzer, MD (Christian-Doppler-Klinik, Salzburg, local site investigator); Walter Schreiber, MD (Donauspital, Vienna, local site investigator); Sabine Torma, MD (Donauspital, Vienna, local site investigator); Regina Katzenschlager, MD (Donauspital, Vienna, local site investigator); Franz Gruber, MD (General Hospital, Linz, local site investigator); Milan R.Vosko, MD (General Hospital, Linz, local site investigator); Gerhard Ransmayr, MD (General Hospital, Linz, local site investigator), Michael Brainin, MD (Hospital Donauregion, Tulln, study coordinator); Claudia Tatschl, MD (Hospital Donauregion, Tulln, local site investigator); Roul Eckhardt, MD (Hospital Donauregion, Tulln, local site investigator); Birgit Glawar, MD (Hospital Göttlicher Heiland, Vienna, local site investigator); Doris Doppelbauer, MD (Hospital Göttlicher Heiland, Vienna, local site investigator); Wolf Muellbacher, MD (Hospital Göttlicher Heiland, Vienna, local site investigator); Dietlind Resch, MD (Hospital Hietzing, Vienna, local site investigator); Martina Mayr, MD (Hospital Hietzing, Vienna, local site investigator) Robert Paur, MD (Hospital Hietzing, Vienna, local site investigator); Otto Berger, MD (Hospital Kaiser Franz-Josef, Vienna, local site investigator); Vera Nussgruber,MD (Hospital Kaiser Franz-Josef, Vienna, local site investigator);Wolfgang Grisold, MD (Hospital Kaiser Franz-Josef, Vienna, local site investigator); Joerg Weber, MD (Hospital Klagenfurt, local site investigator); Gerhard Noisternig, MD (Hospital Klagenfurt, local site investigator); Heinz Kohlfuerst, MD (Hospital Klagenfurt, local site investigator); Klaus Berek, MD (Hospital Kufstein, local site investigator); Markus Mayr, MD (Hospital Kufstein, local site investigator); Stefan Haaser, MD (Hospital Kufstein, local site investigator); Dieter Zeiner, MD (Hospital Mostviertel, Amstetten, local site investigator); Dietmar Schafelner, MD (Hospital Mostviertel, Amstetten, local site investigator); Berthold Kepplinger, MD (Hospital Mostviertel, Amstetten, local site investigator); Marc Rus, MD (Hospital Oberwart, local site investigator); Barbara Muellauer, MD (Hospital Oberwart, local site investigator); Franz Hoeger, MD (Hospital Oberwart, local site investigator); Christian Eggers, MD (Hospital of the Mercy Friars Linz, local site investigator); Christof Bocksrucker, MD (Hospital of the Mercy Friars Linz, local site investigator); Erich Gatterbauer, MD (Hospital Otto Wagner, Vienna, local site investigator); Andrea Hackenbuchner, MD (Hospital Otto Wagner, Vienna, local site investigator); Christian Preiner, MD (Hospital Rudolfstiftung, Vienna, local site investigator); Ursula Paukner, MD (Hospital Rudolfstiftung, Vienna, local site investigator); Elisabeth Fertl, MD (Hospital Rudolfstiftung, Vienna, local site investigator); Herbert Koller, MD (Hospital Sigmund Freud, Graz, local site investigator); Wolfgang Doppler, MD (Hospital Sigmund Freud, Graz, local site investigator); Julia Ferrari, MD (Hospital St. John of God Vienna, local site investigator); Agathe Flamm-Horak, MD (Hospital St. John of God Vienna, local site investigator); Wilfried Lang, MD (Hospital St. John of God Vienna, study coordinator); Nenad Mitrovic, MD (Hospital Vöcklabruck, local site investigator); Thomas Salletmayr, MD (Hospital Vöcklabruck, local site investigator); Monika Grunenberg, MD (Hospital Vöcklabruck, local site investigator); Franz Aichner, MD (Hospital Wagner-Jauregg, Linz, study coordinator); Hanspeter Haring, MD (Hospital Wagner-Jauregg, Linz, local site investigator); Raffi Topakian, MD (Hospital Wagner-Jauregg, Linz, local site investigator); Christian Bancher, MD (Hospital Waldviertel Horn, local site investigator); Konstantin Prass, MD (Hospital Waldviertel Horn, local site investigator); Andreas Doppelbauer, MD (Hospital Weinviertel Mistelbach, local site investigator); Stefan Pingitzer, MD (Hospital Weinviertel Mistelbach, local site investigator); Manfred Eder; MD (Hospital Weinviertel Mistelbach, local site investigator); Isabelle Csmarich, MD (Hospital Wiener Neustadt, local site investigator); Andrea Hager-Seifert,MD (Hospital Wiener Neustadt, local site investigator); Franz Fazekas, MD (Medical University, Graz, local site investigator); Kurt Niederkorn, MD (Medical University, Graz, study coordinator) Susanna Horner, MD (Medical University, Graz, local site investigator); Martin Furtner, MD (Medical University, Innsbruck, local site investigator); Phillip Werner, MD (Medical University, Innsbruck, local site investigator); Georg Wille, MD (Medical University, Innsbruck, local site investigator); Claude Alf, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—1st Department of Neurology, local site investigator); Georg Dimitriadis, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—1st Department of Neurology, local site investigator); Manfred Schmidbauer, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—1st Department of Neurology, local site investigator); Marion Vigl, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—2nd Department of Neurology, local site investigator); Christa Artner, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—2nd Department of Neurology, local site investigator); Christoph Baumgartner, MD (Neurological Center Rosenhügel, Hospital Hietzing Vienna—2nd Department of Neurology, local site investigator); Veronika Dorda, MD (Wilhelminen Hospital, Vienna, local site investigator); Gerhard Daniel, MD (Wilhelminen Hospital, Vienna, local site investigator) Peter Thun, MD (Wilhelminen Hospital, Vienna, local site investigator); Josef Grossmann, MD (Hospital Lienz, local site investigator); Gabi Morgenstern, MD (Hospital Lienz, local site investigator); Nadja Wendlinger, MD (Hospital Lienz, local site investigator); Gesundheit Österreich GmbH/BIQG (M. Moritz, A. Gollmer, R. Kern, L. Seyfang), Steering Group at the GÖG/BIQG (Head: W. Lang).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ferrari, J., Seyfang, L. & Lang, W. Can online benchmarking increase rates of thrombolysis? Data from the Austrian stroke unit registry. J Neurol 260, 2271–2278 (2013). https://doi.org/10.1007/s00415-013-6964-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-013-6964-5

Keywords

Search

Navigation