Healthcare data and benchmarking of stroke centers save the lives of patients with cerebrovascular strokes

Background: In 2019, the Czech Republic implemented a national benchmarking system to improve the quality of stroke care through the integration of administrative health insurance data and clinical registry information. The system was designed to engage all relevant stakeholders—including stroke centers, the Ministry of Health, health insurance funds, and professional societies—in a framework of shared accountability and data-driven governance. Methods: A retrospective analysis was conducted using nationwide data from 2019–2023. Quality indicators were derived from the National Registry of Reimbursed Health Services (NRRHS) and the Registry of Stroke Care Quality (RES-Q). We assessed changes in 5-, 30-, and 90-day case fatality rates; treatment rates (intravenous thrombolysis and mechanical thrombectomy); process times; intensive care access rates; and secondary prevention prescription rates. Statistical significance was evaluated via chi-square and Mann‒Whitney U tests. Risk-standardized mortality rates were calculated via logistic regression adjusted for age, sex, and comorbidities. Results: Between the initial year, 2019, and the last year, 2023, significant improvements were observed in most indicators. The 30-day case fatality rate decreased from 12.40–11.45% (p < 0.001), and the 90-day fatality rate decreased from 18.50–15.99% (p < 0.001). The rate of intravenous thrombolysis increased from 34.29–40.58%, and that of mechanical thrombectomy increased from 10.12–12.68% (both p < 0.001). Intensive care management increased from 61.82–69.05%, and prescriptions for statins, antihypertensive drugs, and anticoagulants also improved significantly. The median door-to-needle time (DNT) remained stable at 22 minutes, whereas the door-to-imaging time (DIT) and groin-to-recanalization time (GRT) significantly decreased (p < 0.001). The 5-day case fatality rate increased slightly (5.04–5.32%, p < 0.001). Conclusions: The implementation of a national benchmarking system integrating administrative and registry data and engaging all relevant stakeholders was associated with measurable improvements in stroke care quality in the Czech Republic. The model promotes continuous quality improvement despite limited financial resources and offers a scalable and transferable framework for other healthcare systems. Ongoing enhancements—including the inclusion of NIHSS scores, mRS90 outcomes, and refined time-based metrics—will further support transparency and effectiveness in stroke care delivery.