Methodological issues in monitoring health services and outcomes for stroke survivors: A case study

BackgroundObtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the National Institutes of Health and the Istituto Superiore di Sanità (its Italian equivalent) to foster collaborative research on rehabilitation.ObjectiveThe purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany.MethodsThis study used qualitative and quantitative methods to study health resources available to and used by stroke survivors during the first 12 months poststroke in two Italian health authorities (AUSLs 10 and 11). Mortality rates were used as an outcome measure.ResultsNumber of inpatient days, number of prescriptions, and prescription costs were significantly higher for patients in AUSL 10 compared with AUSL 11. There was no significant difference between mortality rates.ConclusionUsing administrative data to monitor process and outcomes for chronic stroke has the potential to save money and improve outcomes. However, measures of functional impairment and more sensitive outcome measures than mortality are important. Additional recommendations for enhanced data collection and reporting are discussed.