Quality of hospital care for stroke patients in the Netherlands

To assess the quality of some aspects of medical hospital care an explicit review instrument (a 'criteria map') was developed on the basis of available evidence and consensus statements. The criteria are presented as 'optimal care trajectories', which depend on the patient's clinical profile. The criteria map was applied in a study of 738 stroke patients over 45 years of age. We observed for 44% of the 738 studied patients one or more deviations from the optimal care trajectory with respect to at least one of five important aspects of medical care (CT scan, reversal of anticoagulation, treatment of hypertension, antiplatelet therapy, and evaluation of carotid arteries). The frequency of deviations from optimal care increased with patients' age and level of disability. We conclude that the criteria map is a reliable tool for case-by-case review of the quality of care.