Examining Hospital Variation on Multiple Indicators of Stroke Quality of Care

 You can tell from the title that this was not correctly examined.  'Care' NOT RESULTS! Survivors don't give a crap about care,they want 100% recovery. Nothing here will get them there.

There is no quality here if you don't measure the right things.

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?

3. rehab full recovery? Better than 10%?

 

Examining Hospital Variation on Multiple Indicators of Stroke Quality of Care

Peter C. Austin

,

Jiming Fang

,

Bing Yu

,

Moira K. Kapral

Originally published26 Nov 2020https://doi.org/10.1161/CIRCOUTCOMES.120.006968Circulation: Cardiovascular Quality and Outcomes. ;0

Abstract

Background

Provider profiling involves comparing the performance of hospitals on indicators of quality of care. Typically, provider profiling examines the performance of hospitals on each quality indicator in isolation. Consequently, one cannot formally examine whether hospitals that have poor performance on one indicator also have poor performance on a second indicator.

Methods

We used Bayesian multivariate response random effects logistic regression model to simultaneously examine variation and covariation in multiple binary indicators across hospitals. We considered 7 binary patient-level indicators of quality of care for patients presenting to hospital with a diagnosis of acute stroke. We examined between-hospital variation in these 7 indicators across 86 hospitals in Ontario, Canada.

Results

The number of patients eligible for each indicator ranged from 1321 to 14 079. There were 7 pairs of indicators for which there was a strong correlation between a hospital’s performance on each of the 2 indicators. Twenty-nine of the 86 of hospitals had a probability higher than 0.90 of having worse performance than average on at least 4 of the 7 indicators. Seven of the 86 of hospitals had a probability higher than 0.90 of having worse performance than average on at least 5 indicators. Fourteen of the 86 of hospitals had a probability higher than 0.50 of having worse performance than average on at least 6 indicators. No hospitals had a probability higher than 0.50 of having worse performance than average on all 7 indicators.

Conclusions

These findings suggest that there are a small number of hospitals that perform poorly on at least half of the quality indicators, and that certain indicators tend to cluster together. The described methods allow for targeting quality improvement initiatives at these hospitals.

Footnotes

Peter C. Austin, PhD, ICES, G106, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada. Email peter.austin@ices.on.ca