Background and aim
Benchmarking
is a management approach for implementing best medical practices at the
lowest cost. The objectives of this study were to set achievable
performance benchmarks for individual quality indicators to determine
the predicted quality achievement related to better adherence, and to
select optimal quality indicators for improving the quality of acute
ischemic stroke care.
Methods
We
analyzed data on 500,331 patients diagnosed with acute ischemic stroke
who were treated at 518 hospitals in China from January 2011 to May
2017. The primary outcome was independence (modified Rankin Scale score
≤2) at discharge. Data-driven achievable benchmarking used the
“pared-mean” approach to set objective performance targets. Hierarchical
logistic regression models were employed to evaluate the
process–outcome association, as well as the predicted quality
improvement if all hospitals were to operate at the benchmark level.
Results
Of
the overall population, 64.01% were independent patients at discharge.
The performance benchmarks were >90% for most of the quality
indicators. After adjusting for patient-level and hospital-level
characteristics and unifying hospital performance to the benchmark
level, the quality indicators with high increase in both overall
adherence rate and independence rate were thrombolytic therapy,
anticoagulant therapy, venous thrombosis prophylaxis.
Conclusions
Performance
targets for three acute treatments, including thrombolytic therapy,
anticoagulant therapy, venous thrombosis prophylaxis, could best
motivate improvements in both overall adherence rate and independence
rate at discharge. The finding suggests that the above three types of
acute treatment should be given priority to improve the quality of acute
ischemic stroke care.
No comments:
Post a Comment