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. 

 

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

Author links open overlay panelSeijiMiuraMD*RyujiMiyataMD, PhD*ShujiMatsumotoMD, PhD*^†TakahiroHigashiMD, PhD^‡YoshinobuWakisakaMD, PhD^§TetsuroAgoMD, PhD^§TakanariKitazonoMD, PhD^§KojiIiharaMD, PhD^#MegumiShimodozonoMD, PhD*

https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.06.028Get 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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© 2019 Published by Elsevier Inc.