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Relationship between hospital performance measures and outcomes in patients with acute ischaemic stroke: a prospective cohort study.

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Date
2018-08
Authors
Zhang, Xinmiao
Li, Zixiao
Zhao, Xingquan
Xian, Ying
Liu, Liping
Wang, Chunxue
Wang, Chunjuan
Li, Hao
Prvu Bettger, Janet
Yang, Qing
Wang, David
Jiang, Yong
Bao, Xiaolei
Yang, Xiaomeng
Wang, Yilong
Wang, Yongjun
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(16 total)
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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 article
Subject
Humans
Brain Ischemia
Registries
Prospective Studies
Aged
Middle Aged
Hospitals
Quality of Health Care
Quality Indicators, Health Care
China
Female
Male
Stroke
Permalink
https://hdl.handle.net/10161/21638
Published Version (Please cite this version)
10.1136/bmjopen-2017-020467
Publication 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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Scholars@Duke

Bettger

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
Yang

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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