Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care A Multilevel Modeling Approach

Background and Purpose—Quality of care may be influenced by patient and hospital factors. Our goal was to use multilevel modeling to identify patient-level and hospital-level determinants of the quality of acute stroke care in a stroke registry. Methods—During 2001 to 2002, data were collected for 4897 ischemic stroke and TIA admissions at 96 hospitals from 4 prototypes of the Paul Coverdell National Acute Stroke Registry. Duration of data collection varied between prototypes (range, 2–6 months). Compliance with 8 performance measures (recombinant tissue plasminogen activator treatment, antithrombotics <24 hours, deep venous thrombosis prophylaxis, lipid testing, dysphagia screening, discharge antithrombotics, discharge anticoagulants, smoking cessation) was summarized in a composite opportunity score defined as the proportion of all needed care given. Multilevel linear regression analyses with hospital specified as a random effect were conducted. Results—The average hospital composite score was 0.627. Ho...