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Uwe Hasenbein

Publications and source records attributed to Uwe Hasenbein.

4 recordsLinked to original sources
PubMed2006

Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR).

BACKGROUND AND PURPOSE: There is no consensus about indicators for measuring quality of acute stroke care in Germany. Therefore, a standardized process was initiated recently to develop and implement evidence-based indicators for the measurement of quality of acute hospital stroke care. METHODS: Quality indicators were developed by a multidisciplinary board between November 2003 and December 2005. The process was initiated by the German Stroke Registers Study Group in cooperation with the German Stroke Society, the German Society of Neurology, the German Stroke Foundation, Regional Offices for Quality Assurance and other experts proven in the field. National and international recommendations were considered during the development process. The process was based on a systematic literature review, an independent external evaluation of the process and its results, and a prospective pilot study to evaluate the defined indicators in clinical practice. RESULTS: Overall a set of 24 indicators was developed to measure performance of acute care hospitals in the 3 health care dimensions structure, process and outcome as well as in 3 treatment phases prehospital, in-hospital/acute and postacute. Practicability of the derived indicators was tested in a prospective pilot study. During a 2-month period, 1006 patients in 13 hospitals were documented. Application of the new indicator set was found to be feasible by participating physicians and hospitals. Median time to document the required information for 1 patient was 5 minutes. Nationwide implementation of the new indicator set within regional registers in Germany started since April 2006. CONCLUSIONS: The development of indicators to measure hospital performance in stroke care is an important step toward improving stroke care on a national level. The chosen standardized evidence-based approach ensures maximal transparency, acceptance and sustainability of the developed indicators in Germany.

Acute Disease↗
PubMed2006

[Clinical neurologists' views on measures influencing the quality of acute stroke care].

BACKGROUND: Legislation, professional medical societies and health care providers urge neurological departments to increase focus on more effective structures and processes. This, however, depends on the appreciation of quality features by the physicians involved. GOAL: The present study aimed to identify neurologists' subjective quality criteria, the analysis of influential factors, and a comparison with existing guidelines. METHOD: In a multicentre survey, 99 registrars and senior registrars from 30 clinical departments of neurology were interviewed. The data were analysed both quantitatively and qualitatively. RESULTS: In the participants' view, the quality of acute stroke care depends upon access to competent care, optimal acute management and the presence of trained and experienced personnel. Some subjective dimensions of service quality are dependent upon the interviewed neurologist's board certification status and the features of the respective department (stroke caseload, implementation of a stroke guideline). In comparison to national guidelines, early secondary prevention is underreported. Interviewed neurologists and guidelines agree on the importance of rapid diagnostic procedures and continuous monitoring. CONCLUSIONS: The focus upon early and rapid diagnosis and treatment underlines the importance of optimal emergency organisation for acute stroke patients. Early secondary prophylaxis, the prevention of complications and rehabilitation management are underestimated as relevant fields of action. Empirical research and medical education should address possible deficits concerning these aspects.

Certification↗
PubMed2006

[Between collegial conversation and controlled trials: hospital-based neurologists' sources of information and their practical knowledge in the treatment of stroke patients].

The application of evidence-based and standardized knowledge is an important basis for coordinated and effective clinical work. A multicenter study, which was conducted in 30 clinical neurology departments and included 99 junior and senior registrars, addressed aspects of practical knowledge of stroke treatment by open structured oral interviews which were analyzed with respect to interphysician and guideline conformity. In addition, the participants were asked to rate the usefulness of various informational sources and describe their informational sources used according to the aspects of practical knowledge addressed. The respective departmental directors were questioned about the sources of medical knowledge accessible in their clinic. In almost all hospitals, physicians had access to a library and the Internet. However, departments differed with respect to their information management (frequency and type of medical education, quality management, participation in research activities). In accordance with other studies, the knowledge sources reported most often were textbooks, journals and clinical studies. For most sources, the usefulness rankings largely corresponded to the rankings of user behavior. Both were only weak predictors for interphysician and guideline conformity. They are more closely related to the within-department homogeneity of practical knowledge than to interdepartmental and guideline conformity. Within-department homogeneity is enhanced by the use of recent, published and evidence-based sources and topical interaction with clinical colleagues. Guideline conformity was related to the use of databases and professional journals. A preference for colleagues from out-patient practices diminished both interphysician and guideline conformity. It seems there is still untapped potential for within-department knowledge management, such as medical education, implementation and use of guidelines and topical discussions, which may enhance the homogeneity and guideline conformity of the practical knowledge that clinicians apply.

Communication↗