Deans' stroke musings: Quality Management Program of Stroke Rehabilitation Using Adherence to Guidelines: A Nationwide Initiative in Japan

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 17, 2019

Quality Management Program of Stroke Rehabilitation Using Adherence to Guidelines: A Nationwide Initiative in Japan

This needs to change from guideline development to protocol development. Guidelines are lazy and not terribly useful in getting to 100% recovery. Survivors need certainty and guidelines don't provide that.

YOUR RESPONSIBILITY is to change that focus from lazy guidelines to protocols.

https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.028 Get rights and content

Abstract

Background and Aim

In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue.

Methods

We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel.

Results

The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators).

Conclusion

This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.

Key Words

Stroke Rehabilitation

quality indicator

healthcare

evidence-based practice

: Financial Disclosures: Dr. Matsumoto reports grant support from Teijin Pharma Limited. Dr. Kitazono reports speaker fees from Bayer Yakuhin Ltd. and Daiichi Sankyo Co. Ltd., consulting fees from Chugai Pharmaceutical Co. Ltd., and grant support from Takeda Pharmaceutical Co. Ltd., Daiichi Sankyo Ltd., Mitsubishi Tanabe Pharma Co., Eisai Co. Ltd., Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., and MSD KK. Dr. Iihara reports grant support from AstraZeneca, Otsuka Pharmaceutical, Nihon Medi-Physics Co. Dr. Shimodozono reports lecture fee from Eli Lilly Japan K.K., and consulting fees from Yaskawa Electric Co. The remaining authors report no conflicts of interest.

: Funding: This work was supported by the Practical Research Project for Life-style related Diseases including Cardiovascular Diseases and Diabetes Mellitus managed by the Japan Agency for Medical Research and Development (AMED) (16ek0210046h0002; Principal Investigator: K.I., Co-Investigator: M.S.). The funder had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish.

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