Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators


  •   Khaled Awawdi

  •   Carmel Armon

  •   Itzhak Kimiagar

  •   Mahdi Tarabeih

  •   Riad Abu Rakia


Background: In 2013 the Israel Ministry of Health identified the care and treatment of acute cerebral ischemic stroke as failing to achieve expected standards. The Ministry decided to raise standards by defining and instituting, nationwide, a battery of linked care quality indicators to be applied across all relevant facilities and contexts. Five indicators were selected for five key junctures in the AIS care process.

Methods: This paper presents and analyses the effects of the implementation of these new care quality indicators on the post-discharge quality of life outcomes of Israeli stroke sufferers. The patient sample comprises patients from Israel’s Central region, where stroke care provision and access is relatively high, and from the peripheral North region, where provision and access are limited.

Results: Those who were not treated with thrombolytic treatment and/or cerebral blood vessel catheterization, those who suffered severer strokes, women, the older age groups, non-Jews and North region residents display significantly worse physical functioning outcomes and worse quality of life outcomes on all indicators.

Conclusions: Stroke care access and provision disparities translate into significantly higher rates of post-discharge disability, impaired physical and social functioning, and a lower quality of life.

The effectiveness of healthcare improvement by the deployment of care indicators is closely associated with the lifestyle, socio-demographic and socioeconomic status of different population groups. The effective implementation of quality care indicators also relies heavily on closing the access and provision gaps between the populations living in central and peripheral areas. Two obvious directions for action are to expand and improve the rehabilitation care network and to combat the age discrimination in hospital stroke treatment.

Keywords: care pathways, disability, ischemic stroke, quality indicators, quality of life, sociodemographic discrimination


Annat A-Z, Ronit P, Micha M, et al. The National Program for Quality Indicators in Hospitals in Israel Report for 2013-2014 [in Hebrew]. Jerusalem; 2015.

Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA - J Am Med Assoc. 2013. doi:10.1001/jama.2013.6959.

Saver JL, Gornbein J, Grotta J, et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window Joint outcome table analysis of the ECASS 3 trial. Stroke. 2009. doi:10.1161/STROKEAHA.108.543561.

Wardlaw JM, Murray V, Berge E, Del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2009. doi:10.1002/14651858.CD000213.pub2.

Racheli D, Dalit L-G. Israeli study: After a stroke women suffer poorer quality of life than men[in Hebrew]. 2015.מחקר-ישראלי-לאחר-שבץ-מוחי-נשים-סובלות-מ/.

Amber Z, Carmit L, Amit R, Rita D, Yael H, Tammy S. National Registry of Strokes in Israel Report for 2015-2014 [in Heabrew]. Jerusalem; 2017.

Nihama G, Miriam A, Ziona H. Leading Causes of Death 2000-2014 in Israel [in Hebrew]. Jerusalem; 2017.

Armon C, Wainstein J, Gour A, et al. CT-guided thrombolytic treatment of patients with wake-up strokes. eNeurologicalSci. 2019. doi:10.1016/j.ensci.2019.02.002.

Kimiagar I, Kalmanovich-Avnery S, Gonen OM, et al. Effect of the 2013 AHA/ASA guidelines on TPA use in acute ischemic stroke at Assaf Harofeh Medical Center in Israel. J Neurol Sci. 2016. doi:10.1016/j.jns.2016.08.038.

Tanne D, M.Bronstein N. National Acute Stroke ISraeli 2013 Registry.; 2013.

Ema A, Shlomit A. Inequality in Health and Dealing with It [in Hebrew]. Jerusalem; 2016.

Ema A. Inequality in Health and Dealing with It: The Welfare of Residents in the Regions of Israel [in Hebrew]. Jerusalem; 2015.

Koton S, Tsabari R, Molshazki N, et al. Burden and Outcome of Prevalent Ischemic Brain Disease in a National Acute Stroke Registry. Stroke. 2013. doi:10.1161/STROKEAHA.113.002174.

Meir H, Eli L, Joseph K. Social Work in Israel [in Hebrew]. (Hakibbutz Hameuchad, ed.). Tel-aviv; 2013.

Robert B, John C, Jenny S. What You Really Need to Know About Caring for Someone After a Stroke. Lebhar-Friedman books; 2000.

Akka-Zohar A, Freedman L, Mandel M, et al. Israeli Program of Health Care Quality Indicators (IPHCQI)[in Hebrew].; 2016.

Averbuch E, Avni S. Inequality in Health and Dealing with It[in Hebrew].; 2016.

Hell S, Haklay Z. Hospital Beds and Licensing Positions [in Hebrew].; 2016.


Download data is not yet available.


How to Cite
Awawdi, K., Armon, C., Kimiagar, I., Tarabeih, M., & Rakia, R. A. (2021). Post-Stroke Quality of Life Outcomes After Instituting New Stroke Care Quality Indicators. European Journal of Medical and Health Sciences, 3(1), 9-15.