Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough

Marzyeh Amini*, Nikki van Leeuwen, Frank Eijkenaar, Maxim J. H. L. Mulder, Wouter Schonewille, Geert Lycklama a 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, Wim van Zwam, MR CLEAN Registry Investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

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

Original languageEnglish
Article number998
Number of pages10
JournalBMC Health Services Research
Volume20
Issue number1
DOIs
Publication statusPublished - 31 Oct 2020

Keywords

  • Stroke
  • Endovascular treatment
  • Benchmarking
  • Quality of care
  • Outcome differences
  • Case-mix
  • Process of care
  • ACUTE ISCHEMIC-STROKE
  • CONSCIOUS SEDATION
  • GENERAL-ANESTHESIA
  • ENDOVASCULAR THROMBECTOMY
  • HOSPITAL VOLUME
  • OF-CARE
  • IMPUTATION
  • THERAPY
  • REPERFUSION
  • MANAGEMENT

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