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This study analyzed stroke mortality in Paraná State, Brazil, in 2007, according to residence and place of death, using the official Mortality Information System. For deaths in individuals 65 years and older and from 45 to 64 years of age, 17.6% and 29.8%, respectively, occurred at home. An association was observed between region of residence and less than three years of schooling (OR = 3.96) four to seven years of schooling (OR = 1.75), and race or skin color (non-white: OR = 1.39). Place of death was associated with age over 65 (OR= 1.69), less than three years of schooling (OR = 1.70), and residence in municipalities other than the respective headquarters of the Regional Health offices (OR = 1.33). The results suggested inequalities in access to hospital care at the time of death from stroke, according to region of residence and socioeconomic variables. The study supports use of the Mortality Information System as a data source to back public health policies and interventions. Further studies are needed to evaluate the factors that influence quality of patient care for stroke and to verify whether the same pattern is repeated in mortality from other causes.

This article reports on the methodology used by the research team of the State University in Maringá in the Baseline Study in 20 municipalities in the States of Paraná and Santa Catarina, Brazil, with more than 100,000 inhabitants each, in the implementation of the Project for Expansion and Consolidation of the Family Health Strategy. Workshops to discuss the evaluation of programs, construction and application of research instruments, site visits to supervise activities in disseminating the program, and development of a database with the local and regional scientific output were carried out. There was an obvious sense of responsibility and commitment on the part of municipal and State representatives, the majority of whom immediately agreed to the activities. They also showed interest in both the learning process and institutionalization of the evaluation. Fourteen municipalities incorporated other actors to build a support network for the evaluation of the primary health care system. The strategies contributed to the incorporation of evaluation into the planning process, indicating that training can be a constructive and powerful mechanism for institutionalizing evaluation.

The work process in the Brazilian Family Health Program (FHP) allows teams to establish bonds, accept families, and take responsibility for the registered population and identify groups at risk. Monitoring allows problem surveying and evaluation of specific measures. Considering that a key objective of controlling arterial hypertension is to reduce stroke mortality, this study aimed to identify the coverage, follow-up, and quality of care for individuals in areas with the FHP who died of stroke, based on data from the family registries (Form A), follow-up (Form B), and patient records in primary health care units. The results showed low coverage, with 33.3% of registration on Form A, follow-up of 4.9% of deaths, and absence of any annotation on the care provided in most patient records (52.4%). Analysis of care in the group confirmed the fragmentation and disconnection between the different information systems. It is essential to encourage the use of available data and improve their recording in order to institutionalize evaluation practice and work organization from a health surveillance perspective.