학술논문
Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough
Document Type
article
Author
Marzyeh Amini; Nikki van Leeuwen; Frank Eijkenaar; Maxim J. H. L. Mulder; Wouter Schonewille; Geert Lycklama à Nijeholt; Wouter H. Hinsenveld; Robert-Jan B. Goldhoorn; Pieter Jan van Doormaal; Sjoerd Jenniskens; Jan Hazelzet; Diederik W. J. Dippel; Bob Roozenbeek; Hester F. Lingsma; on behalf of the MR CLEAN Registry Investigators
Source
BMC Health Services Research, Vol 20, Iss 1, Pp 1-10 (2020)
Subject
Language
English
ISSN
1472-6963
Abstract
Abstract Background Between-center variation in outcome may offer opportunities to identify variation in quality of care. By intervening on these quality differences, patient outcomes may be improved. However, whether observed differences in outcome reflect the true quality improvement potential is not known for many diseases. Therefore, we aimed to analyze the effect of differences in performance on structure and processes of care, and case-mix on between-center differences in outcome after endovascular treatment (EVT) for ischemic stroke. Methods In this observational cohort study, ischemic stroke patients who received EVT between 2014 and 2017 in all 17 Dutch EVT-centers were included. Primary outcome was the modified Rankin Scale, ranging from 0 (no symptoms) to 6 (death), at 90 days. We used random effect proportional odds regression modelling, to analyze the effect of differences in structure indicators (center volume and year of admission), process indicators (time to treatment and use of general anesthesia) and case-mix, by tracking changes in tau 2, which represents the amount of between-center variation in outcome. Results Three thousand two hundred seventy-nine patients were included. Performance on structure and process indicators varied significantly between EVT-centers (P