Computed tomographic brain scans and antiplatelet therapy after stroke: a study of the quality of care in Dutch hospitals

Stroke; a Journal of Cerebral Circulation
J H van der MeulenJ D Habbema

Abstract

We sought to develop a measure ("quality weight" that indicates the severity of a deviation from optimal care with respect to secondary prevention with antiplatelet treatment after stroke. We also sought to estimate the effects that efforts to improve the quality of secondary prevention may have on health outcome and healthcare costs in the Netherlands. First, we developed quality weights with decision analysis techniques. These quality weights express the excess risk of vascular events in the first 2 years after stroke compared with the optimal strategy (CT brain scan in all patients and aspirin in case of cerebral infarction). Second, these weights were applied in a follow-up study of 738 stroke patients older than 45 years. The number of stroke patients admitted to a hospital in 1991 in the Netherlands was used to estimate nationwide effects. We used data from 23 neurological departments and from the Information Center for Health Care in the Netherlands. The 2-year excess risk of fatal and nonfatal vascular events caused by omitting CT brain scan and giving aspirin to all patients is rather small (on average, 0.6%). The 2-year excess risk caused by not giving aspirin to a patient with cerebral infarction is much higher (4.1%...Continue Reading

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Citations

Aug 23, 2002·Journal of Internal Medicine·S P EfstathiouT D Mountokalakis
Nov 27, 2002·Clinical and Experimental Hypertension : CHE·Nicola TambascoVirgilio Gallai

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