TY - JOUR
T1 - Improving quality of stroke care through benchmarking center performance
T2 - why focusing on outcomes is not enough
AU - Amini, Marzyeh
AU - van Leeuwen, Nikki
AU - Eijkenaar, Frank
AU - Mulder, Maxim J. H. L.
AU - Schonewille, Wouter
AU - Nijeholt, Geert Lycklama a
AU - Hinsenveld, Wouter H.
AU - Goldhoorn, Robert-Jan B.
AU - van Doormaal, Pieter Jan
AU - Jenniskens, Sjoerd
AU - Hazelzet, Jan
AU - Dippel, Diederik W. J.
AU - Roozenbeek, Bob
AU - Lingsma, Hester F.
AU - van Zwam, Wim
AU - MR CLEAN Registry Investigators
N1 - Publisher Copyright:
© 2020, The Author(s).
PY - 2020/10/31
Y1 - 2020/10/31
N2 - BackgroundBetween-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.MethodsIn 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 90days. 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.ResultsThree thousand two hundred seventy-nine patients were included. Performance on structure and process indicators varied significantly between EVT-centers (P
AB - BackgroundBetween-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.MethodsIn 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 90days. 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.ResultsThree thousand two hundred seventy-nine patients were included. Performance on structure and process indicators varied significantly between EVT-centers (P
KW - Stroke
KW - Endovascular treatment
KW - Benchmarking
KW - Quality of care
KW - Outcome differences
KW - Case-mix
KW - Process of care
KW - ACUTE ISCHEMIC-STROKE
KW - CONSCIOUS SEDATION
KW - GENERAL-ANESTHESIA
KW - ENDOVASCULAR THROMBECTOMY
KW - HOSPITAL VOLUME
KW - OF-CARE
KW - IMPUTATION
KW - THERAPY
KW - REPERFUSION
KW - MANAGEMENT
U2 - 10.1186/s12913-020-05841-y
DO - 10.1186/s12913-020-05841-y
M3 - Article
C2 - 33129362
SN - 1472-6963
VL - 20
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - 1
M1 - 998
ER -