Relationship between hospital performance measures and outcomes in patients with acute ischaemic stroke: a prospective cohort study.
Abstract
OBJECTIVE:Evidence-based performance measures have been increasingly used to evaluate
hospital quality of stroke care, but their impact on stroke outcomes has not been
verified. We aimed to evaluate the correlations between hospital performance measures
and outcomes among patients with acute ischaemic stroke in a Chinese population. METHODS:Data
were derived from a prospective cohort, which included 120 hospitals participating
in the China National Stroke Registry between September 2007 and August 2008. Adherence
to nine evidence-based performance measures was examined, and the composite score
of hospital performance measures was calculated. The primary stroke outcomes were
hospital-level, 30-day and 1-year risk-standardised mortality (RSM). Associations
of individual performance measures and composite score with stroke outcomes were assessed
using Spearman correlation coefficients. RESULTS:One hundred and twenty hospitals
that recruited 12 027 patients with ischaemic stroke were included in our analysis.
Among 12 027 patients, 61.59% were men, and the median age was 67 years. The overall
composite score of performance measures was 63.3%. The correlation coefficients between
individual performance measures ranged widely from 0.01 to 0.66. No association was
observed between the composite score and 30-day RSM. The composite score was modestly
associated with 1-year RSM (Spearman correlation coefficient, 0.34; p<0.05). The composite
score explained only 2.53% and 10.18% of hospital-level variation in 30-day and 1-year
RSM for patients with acute stroke. CONCLUSIONS:Adherence to evidence-based performance
measures for acute ischaemic stroke was suboptimal in China. There were various correlations
among hospital individual performance measures. The hospital performance measures
had no correlations with 30-day RSM rate and modest correlations with 1-year RSM rate.
Type
Journal articleSubject
HumansBrain Ischemia
Registries
Prospective Studies
Aged
Middle Aged
Hospitals
Quality of Health Care
Quality Indicators, Health Care
China
Female
Male
Stroke
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https://hdl.handle.net/10161/21638Published Version (Please cite this version)
10.1136/bmjopen-2017-020467Publication Info
Zhang, Xinmiao; Li, Zixiao; Zhao, Xingquan; Xian, Ying; Liu, Liping; Wang, Chunxue;
... Wang, Yongjun (2018). Relationship between hospital performance measures and outcomes in patients with acute
ischaemic stroke: a prospective cohort study. BMJ open, 8(7). pp. e020467. 10.1136/bmjopen-2017-020467. Retrieved from https://hdl.handle.net/10161/21638.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Janet Prvu Bettger
Adjunct Associate in the Department of Orthopaedic Surgery
Dr. Bettger’s research is dedicated to establishing real world evidence aimed to improve
health care quality and policies that reduce the burden of disease and disability.
As a health services researcher and implementation scientist, her research extends
from observational studies to randomized and pragmatic trials. She is currently the
Director of Duke Roybal Center for Translational Research in the Behavioral and Social
Sciences of Aging and Director of Undergraduate Initiatives
Ying Xian
Adjunct Associate Professor in the Department of Neurology
Qing Yang
Associate Research Professor in the School of Nursing
Dr. Qing Yang is Associate Professor and Biostatistician at Duke School of Nursing.
She received her PhD in Biostatistics from University of California, Los Angeles.
Dr. Yang’s statistical expertise is longitudinal data analysis and time-to-event data
analysis. As a biostatistician, she has extensive experience collaborating with researchers
in different therapeutic areas, including diabetes, cancer, cardiovascular disease
and mental health. Her current research interests are advanced late
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