Measuring Quality of Care for Ischemic Stroke Treated With Acute Reperfusion Therapy in Japan - The Close The Gap-Stroke

Nice Ren, Ataru Nishimura, Ai Kurogi, Kunihiro Nishimura, Ryu Matsuo, Kuniaki Ogasawara, Yoichiro Hashimoto, Takahiro Higashi, Nobuyuki Sakai, Kazunori Toyoda, Yoshiaki Shiokawa, Teiji Tominaga, Shigeru Miyachi, Akiko Kada, Keisuke Abe, Kotaro Ono, Kazunori Matsumizu, Koichi Arimura, Takanari Kitazono, Susumu MiyamotoKazuo Minematsu, Koji Iihara

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


BACKGROUND: In Japan there is no consensus on how to efficiently measure quality indicators (QIs), defined as a standard of care, for acute ischemic stroke (AIS). Using information from a health insurance claims database and electronic medical records, we evaluated the feasibility and validity of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) or endovascular therapy (EVT).Methods and Results:AIS patients receiving rt-PA or EVT between 2013 and 2015 were identified. We selected 17 AIS QI measures for primary stroke centers (PSCs) and 8 for comprehensive stroke centers (CSCs). Defined QIs were calculated for each hospital and then averaged. In total, the data of 8,206 patients (rt-PA 83.7%, EVT 34.9%) from 172 hospitals were obtained. Median National Institute of Health Stroke Scale score at admission was 14, and 37.7% of the patients were functionally independent at discharge. All target QIs were successfully measured with fewer missing values, and the accuracy of preset data was about 90%. Adherence rates were low (<50%) in 5 QI measures among PSCs, including door-to-needle time ≤1 h, and in 1 QI measure among CSCs (door-to-brain and vascular imaging time ≤30 min). CONCLUSIONS: Measuring QIs for AIS by this novel approach was feasible and reliable in the provision of a national benchmark.

Original languageEnglish
Pages (from-to)201-209
Number of pages9
JournalCirculation journal : official journal of the Japanese Circulation Society
Issue number2
Publication statusPublished - Jan 25 2021

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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