학술논문
Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care.
Document Type
Academic Journal
Author
Amini M; Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands.; Eijkenaar F; Erasmus School of Health Policy and Management Erasmus University Rotterdam Rotterdam The Netherlands.; Lingsma HF; Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands.; den Hartog SJ; Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands.; Department of Radiology and Nuclear Medicine Erasmus University Medical Center Rotterdam The Netherlands.; Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands.; Olthuis SGH; Department of Neurology Maastricht University Medical Center and School for Cardiovascular Diseases Maastricht The Netherlands.; Martens J; Department of Radiology Rijnstate Arnhem The Netherlands.; van der Worp B; Department of Neurology and Neurosurgery, Brain Center University Medical Center Utrecht, Utrecht University Utrecht The Netherlands.; van Zwam W; Department of Neurology Maastricht University Medical Center and School for Cardiovascular Diseases Maastricht The Netherlands.; Department of Radiology and Nuclear Medicine Maastricht University Medical Center, Cardiovascular Research Institute Maastricht Maastricht The Netherlands.; van der Hoorn A; Department of Radiology, Medical Imaging Center University Medical Center Groningen Groningen The Netherlands.; Roosendaal SD; Department of Radiology and Nuclear Medicine Amsterdam University Medical Center Amsterdam The Netherlands.; Roozenbeek B; Department of Radiology and Nuclear Medicine Erasmus University Medical Center Rotterdam The Netherlands.; Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands.; Dippel D; Department of Neurology Erasmus University Medical Center Rotterdam The Netherlands.; van Leeuwen N; Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE
Subject
Language
English
Abstract
Background Insight into outcome variation between hospitals could help to improve quality of care. We aimed to assess the validity of early outcomes as quality indicators for acute ischemic stroke care for patients treated with endovascular therapy (EVT). Methods and Results We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, a large multicenter prospective cohort study including 3279 patients with acute ischemic stroke undergoing EVT. Random effect linear and proportional odds regression were used to analyze the effect of case mix on between-hospital differences in 2 early outcomes: the National Institutes of Health Stroke Scale (NIHSS) score at 24 to 48 hours and the expanded thrombolysis in cerebral infarction score. Between-hospital variation in outcomes was assessed using the variance of random hospital effects (tau 2 ). In addition, we estimated the correlation between hospitals' EVT-patient volume and (case-mix-adjusted) outcomes. Both early outcomes and case-mix characteristics varied significantly across hospitals. Between-hospital variation in the expanded thrombolysis in cerebral infarction score was not influenced by case-mix adjustment (tau 2 =0.17 in both models). In contrast, for the NIHSS score at 24 to 48 hours, case-mix adjustment led to a decrease in variation between hospitals (tau 2 decreases from 0.19 to 0.17). Hospitals' EVT-patient volume was strongly correlated with higher expanded thrombolysis in cerebral infarction scores ( r =0.48) and weakly with lower NIHSS score at 24 to 48 hours ( r =0.15). Conclusions Between-hospital variation in NIHSS score at 24 to 48 hours is significantly influenced by case-mix but not by patient volume. In contrast, between-hospital variation in expanded thrombolysis in cerebral infarction score is strongly influenced by EVT-patient volume but not by case-mix. Both outcomes may be suitable for comparing hospitals on quality of care, provided that adequate adjustment for case-mix is applied for NIHSS score.