ESO East Supplement 2023 - 42

42
European Stroke Journal 8(1S)
actively involved in the project. The joint Declaration for
Action on Stroke is signed by all participants and the goals
for the first year have been made.
Strengths and limitations of the study
The data from the RES-Q database are collected only once
a year and thereby the number of cases is small with only
limited power to be used for comparisons. However, as
other data resources are available for the whole country, we
can confirm, that the RES-Q data are in line with data from
national quality indicators. One limitation of the RES-Q is
manual and voluntary data entry with insufficient quality
control. These limitations can be overcome by auditing and
stricter definition of the collected variables, and this should
be addressed in the future.2
RES-Q data are collected in an unblinded manner during
1 month annually causing possibly performance bias. Most
of the indicators rely on a comprehensive collaboration
between pre-hospital and hospital staff on a pre-specified
standard operating procedure implemented in the hospitals.
We think that it is unlikely that the quality of care can be
improved for 1 month only deriving from the fact that the
quality is being monitored. Therefore, in addition to the
RES-Q database, we presented the data of the national
quality indicators in which all stroke cases in Estonia are
included. As these variables are collected from the EHIF
reimbursement database, those may therefore contain errors
due to retrospective nature. However, the temporal trend
can be analyzed as the methodology is unchanged.
Future perspectives
The continuous work on the stroke quality care over the
past decades in Estonia has created a good basis for further
developments. The Action Plan for Stroke in Europe has
just begun and will hopefully add significant improvements
in many areas of stroke care. Our priorities include continuous
monitoring of quality indicators (including expanding
the data collection into the RES-Q database, continuing
with SITS registry, and national quality indicators), development
of a digitalized platform for modern data collection
(i.e. establishing Estonian Stroke Registry), continuous
educational programs for stroke neurologists and other
members of the stroke care team, improvement of secondary
prevention strategies and ESO certification of stroke
units in our country.
Conclusions
The trends of quality of acute stroke care in Estonia show
improvement, however more emphasis should be paid on
rehabilitation and secondary prevention. Together with the
national quality indicators the RES-Q provide an excellent
opportunity for monitoring the trends of stroke care and
comparisons both national and international level.
Acknowledgements
The authors acknowledge the colleagues from five departments
who contributed to the RES-Q, and the Irene Cost Action
CA18118 for non-financial support.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
Informed consent
No signed informed consent was obtained because of analysis of
anonymous data from the Estonian Health Insurance Fund and the
RES-Q.
Ethical approval
No ethical approval was obtained because of analysis of anonymous
data from the Estonian Health Insurance Fund and the
RES-Q.
Guarantor
Janika Kõrv.
Author contributions
JK and RV contributed to conception and study design. JK, RV,
IK, KGP, AK, AL, and KA contributed to acquisition and analysis
of data. JK and RV contributed to drafting of the manuscript and
figures. IK, KGP, AK, AL, and KA contributed with critical comments
during manuscript revision. All authors approved the submitted
manuscript.
ORCID iDs
Janika Kõrv
Riina Vibo
https://orcid.org/0000-0002-6074-0727
https://orcid.org/0000-0001-9138-3227
Data availability statement
The data that support the findings of this study are available from
the corresponding author (JK), upon reasonable request.
References
1. Feigin VL, Stark BA, Johnson CO, et al. Global, regional,
and national burden of stroke and its risk factors, 1990-2019:
a systematic analysis for the Global Burden of Disease Study
2019. Lancet Neurol 2021; 20: 795-820.
2. Mikulík R, Caso V, Bornstein NM, et al. Enhancing and
accelerating stroke treatment in Eastern European region:
methods and achievement of the ESO EAST program. Eur
Stroke J 2020; 5: 204-212.
3. Aguiar de Sousa D, von Martial R, Abilleira S, et al. Access
to and delivery of acute ischaemic stroke treatments: a survey
of national scientific societies and stroke experts in 44
European countries. Eur Stroke J 2019; 4: 13-28.
https://www.orcid.org/0000-0002-6074-0727 https://www.orcid.org/0000-0001-9138-3227
ESO East Supplement 2023

Table of Contents for the Digital Edition of ESO East Supplement 2023
