Clinical and organizational stroke care quality performance by sex and age among stroke patients in differently-designated Quebec hospital centers: a retrospective study

Background The quality of interdisciplinary care in the acute phase of ischemic stroke remains unexplored in Quebec and the rest of Canada. Clinical and organizational indicators across differently-designated hospital centers must be evaluated while considering individual patient characteristics in order to better understand and improve these care practices. Objective To describe the performance of care and services based on measurement of clinical and organizational quality indicators in the acute ischemic stroke phase according to sex and age in differently-designated Quebec hospital centers. Method A retrospective descriptive study was conducted on patients‘ health records in three centers (levels 3, 4, and 5) using 29 clinical and organizational quality indicators. Differences based on age and sex were analyzed using Chi-square tests including bootstrapping techniques (x 5 000) with a 95% CI and MoE at 5%. Results We studied 132 patients‘ health records (mean age, 73.5 years; 53% women). Examples of indicators whose results revealed disparities calling for improved practices include the assessment of stroke severity using the NIHSS, which was carried out for 32.6% of patients, fall risk screening for 51.2%, secondary prevention referral at discharge for 45.1%, and pre-discharge stroke education documented in patients‘ health records for less than 50.0% of patients. On the other hand, assessment of dysphagia (78.6%), investigation of cardiac arrhythmias (95.5%) and admission in a stroke unit (88.3%) are examples of indicators that performed favorably in relation to clinical and organizational practices. Antiplatelet prescription (p = 0.007) and secondary prevention referral (p = 0.003) at discharge decreased with age, while the use of social work resources was higher in the over-80s subgroup (p = 0.003). Arrhythmia screening was performed more frequently in men (p = 0.018). Conclusion This first Quebec multicentric study in Canada, presented by age and sex, will enable optimized health outcomes for vulnerable populations by reducing health disparities and lead to improved management of resources as needed while improving patient care.