Anti-accreditation for stroke management in Taiwan


  • Conflict of interest: None declared.

Correspondence: Cheng-Yang Hsieh, Department of Neurology, Tainan Sin Lau Hospital. EEG room, 4F, NO. 57, Sec. 1, Dong Men Road, East Dist., Tainan 70142.


To the editor:

To improve the treatment quality of acute ischemic stroke, the Taiwan Department of Health (DOH) had reinforced every secondary or tertiary referral hospital to improve the use of thrombolytic therapy through a strategy of nationwide accreditation since 2010. Though the accreditation was not accompanied by concomitantly increased reimbursement for service from National Health Insurance, hospitals should fulfill all the required criteria of ‘quality indicators’ for stroke treatment. For example, the proportion of door-to-needle time ≤60 min for all stroke patients receiving thrombolytic therapy ‘should’ be >50% in a tertiary referral center. This had led strong argument from members of the Taiwan Neurology Society (TNS) and some considered such abnormally high target of ‘quality indicator’ was like another Great Leap Forward or Chinese Cultural Revolution. Some worried about the great burden of thrombolytic therapy may result in reluctance of young doctor to apply neurologic training program and further burnout neurologists in clinical practice. Legal issues had also been raised because the bleeding risk after thrombolytic therapy was higher for patients in Taiwan than those in the western countries [1], and the optimal dose of thrombolytic agents for the Taiwanese population still remained controversial [2, 3]. Activity against the unreasonable accreditation was initiated six-months ago by Dr Chih-Ta Tai on the Facebook® and about 300 neurologists joined it. On April 13, 2013, after several vigorous debates, members of TNS in their annual meeting had finally approved a task force to discuss with DOH and try to change such situation.