IS IN-HOSPITAL STROKE MORTALITY AN ACCURATE MEASURE OF QUALITY OF CARE

We examined the validity of using in-hospital stroke mortality as pred icted by the Cleveland Hospital Outcomes Indicators of Care Evaluation s (CHOICE) model as a measure of quality of care. A total of 223 patie nts admitted to the hospital for stroke were evaluated by the CHOICE m odel, which predicted that 19 stroke deaths would occur. We reviewed t he 19 patients with the highest predicted mortality, according to CHOI CE, and three additional patients who died following stroke. We found that The CHOICE model accurately predicts in-hospital stroke mortality for large populations but not for individual patients. CHOICE and oth er stroke outcome models rely heavily on early Do Not Resuscitate orde rs and coma but exclude important variables found in the literature on stroke. No correlation between in-hospital stroke mortality and quali ty of care was demonstrated. Mortality prediction models used to guide consumers on where to receive stroke care are potentially misleading, as they do not assess functional neurologic recovery or the process o f care that are essential elements of quality.