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"Patients have a right to expect that . . .they get a first class service. And in a first class service there is no room for second best". 1 About 100 000 people in England and Wales have a first stroke annually. 2 Stroke patients occupy 20% of acute medical beds in the NHS. 3 Stroke patients require access to quality services appropriate to their needs. The purpose of this article is to review the methods by which clinicians can measure quality of stroke care and the limitations of such measures.
Lohr and Schroeder defined quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". 4 Donabedian developed guidelines for assessing quality of care. 5 These guidelines take into account the outcome, process, and structure of care.
The outcome of care indicates the effects of care on individuals. In the context of stroke care, outcomes may include death or disability.
The process of care refers to the characteristics of available services. 6 In stroke care, process measures may include access to radiological investigations.
The structure of care is "the facilities, equipment, services and manpower available for care and the credentials and qualifications of the health care professionals involved". 7 Availability of trained multidisciplinary staff is one measure of the care structure.
Data were drawn from published articles to prepare this paper. Relevant articles were found by searching for the following Medline keywords: stroke, quality, outcome of care, process of care, structure of care. Articles that examined how to measure the quality of stroke care and articles that examined difficulties in the measurement of care outcomes, processes, and structures were selected. The selected articles were reviewed to summarise the methods by which clinicians can measure quality of stroke care and to summarise the limitations of these methods.
The data from the studies were then put together. Issues related to the measurement of outcomes of stroke care were discussed and summarised in a section entitled "issues concerning outcome of care measures". Conclusions about the best ways to measure the outcomes of stroke care were then drawn-in a section entitled "which outcome measure?"
This method was repeated in the sections...