National Performance Assessment 2011 – Quality and Efficiency of Stroke Care in Sweden

This report aims to monitor and assess the quality of Swedish stroke care. Important areas of improvement are identified, such as reducing waiting times and increasing collaboration between municipalities and county councils.


Annex 4 Figures


Collaboration between municipalities and county councils leads to better outcome for people who have had a stroke. This is proved in the National Board of Health and Welfare's National Performance Assessment of Stroke Care. Data from surveys of stroke units and municipalities shows that, in 44% of municipalities, both county councils and municipalities indicated that they collaborate, or have procedures in place for collaboration regarding rehabilitation of stroke patients. In these municipalities, several outcome indicators such as health and well-being, depression and fulfilled needs for rehabilitation after hospitalisation point at better performance than in municipalities where municipalities and county councils do not collaborate on rehabilitation.

Mortality rates and the ability to manage activities in daily life (ADL) have only improved marginally over the past ten years. The proportion of patients who are readmitted to hospital for stroke or other cardiovascular diseases has not declined to any great extent, despite access to better secondary preventive treatments. Variations between municipalities are considerable, including the proportion of persons who are depressed one year after stroke onset. Based on the findings of this assessment, the National Board of Health and Welfare has identified a number of areas for improvement of stroke care:

  • Reduce waiting times for stroke care.
  • Increase the proportion of patients receiving care in designated stroke units.
  • Improve secondary preventive pharmaceutical treatment.
  • Respond to the need for carotid surgery.
  • Improve rehabilitation both during and after hospitalisation.
  • Provide better psycho-social support.

With more investments in these areas and through better compliance with National Guidelines, the performance in terms of reduced mortality, ADL dependence and depression could be improved and the variations between the county councils and municipalities could also decrease.

Many municipalities do not offer post-stroke rehabilitation, even though they are required to do so by law. The assessment has also identified that people in need of rehabilitation and assistive devices after stroke risk not receiving what they need. A county council may enter into different agreements with municipalities regarding home-based medical and nursing care, consequently it may be difficult for people who have had a stroke and their relatives, to know who is responsible and who to turn to if they need rehabilitation or assistive devices.

Persons who live in normal housing where the municipality is responsible for home-based medical and nursing care have better patient-reported outcome in terms of health and well-being, depression and fulfilled needs for support needs and help after hospitalisation, than persons who live in municipalities where county council primary health care is responsible for their medical care.

Many relatives and family members to persons who have had a stroke report that they are in need of further information and knowledge about stroke as a medical condition and how it develops and progresses, as well as specific information on various treatments. Relatives also report that stroke has major implications for them, for example, their freedom of action becomes limited. Only a small proportion of relatives and families indicate they have received support from the municipality, although the municipality is required to provide this by law.

Approximately twice as many men as women receive day-or team rehabilitation after stroke. Regardless of gender and age, patient-reported outcome appears better for persons with day- or team rehabilitation than those who receive home-based rehabilitative care. It is, however, unclear what is included and who is responsible for the different types of rehabilitation. Women and men should receive day- or team rehabilitation to the same ex-tent and home-based rehabilitation needs improvement.

People who have had a stroke seek dental care to a lesser extent than the population in general. Visits to the dentist play an important role in preventing dental and mouth problems that can arise after a stroke.

The National Board of Health and Welfare will, within a few years, reassess the performance of stroke care. The recommendations and the areas for improvement identified in this assessment will specifically be monitored. Aspects of stroke care not captured in this report may also be evaluated in the future. The National Board of Health and Welfare expects the county councils and the municipalities to use this report as the basis of their work to further improve stroke care. 

Read the full Summary


Year: 2013
Article number: 2013-3-4
ISBN: 978-91-7555-035-0
Format: Bok
Pages: 86
Language: Engelska
Price (VAT included): 115 kr


Björn Nilsson
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