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1. Between-hospital variation in indicators of quality of care: a systematic review.

Author

van der Linde M, Salet N, van Leeuwen N, Lingsma HF, and Eijkenaar F

Subjects
Humans, Quality of Health Care standards, Quality Indicators, Health Care, Hospitals standards
Abstract

Background: Efforts to mitigate unwarranted variation in the quality of care require insight into the 'level' (eg, patient, physician, ward, hospital) at which observed variation exists. This systematic literature review aims to synthesise the results of studies that quantify the extent to which hospitals contribute to variation in quality indicator scores., Methods: Embase, Medline, Web of Science, Cochrane and Google Scholar were systematically searched from 2010 to November 2023. We included studies that reported a measure of between-hospital variation in quality indicator scores relative to total variation, typically expressed as a variance partition coefficient (VPC). The results were analysed by disease category and quality indicator type., Results: In total, 8373 studies were reviewed, of which 44 met the inclusion criteria. Casemix adjusted variation was studied for multiple disease categories using 144 indicators, divided over 5 types: intermediate clinical outcomes (n=81), final clinical outcomes (n=35), processes (n=10), patient-reported experiences (n=15) and patient-reported outcomes (n=3). In addition to an analysis of between-hospital variation, eight studies also reported physician-level variation (n=54 estimates). In general, variation that could be attributed to hospitals was limited (median VPC=3%, IQR=1%-9%). Between-hospital variation was highest for process indicators (17.4%, 10.8%-33.5%) and lowest for final clinical outcomes (1.4%, 0.6%-4.2%) and patient-reported outcomes (1.0%, 0.9%-1.5%). No clear pattern could be identified in the degree of between-hospital variation by disease category. Furthermore, the studies exhibited limited attention to the reliability of observed differences in indicator scores., Conclusion: Hospital-level variation in quality indicator scores is generally small relative to residual variation. However, meaningful variation between hospitals does exist for multiple indicators, especially for care processes which can be directly influenced by hospital policy. Quality improvement strategies are likely to generate more impact if preceded by level-specific and indicator-specific analyses of variation, and when absolute variation is also considered., Prospero Registration Number: CRD42022315850., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Published
2024
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2. Changes in hospital variation in the probability of receiving treatment with curative intent for esophageal and gastric cancer.

Author

Luijten JCHBM, Vissers PAJ, Lingsma H, van Leeuwen N, Rozema T, Siersema PD, Rosman C, van Laarhoven HWM, Lemmens VEP, Nieuwenhuijzen GAP, and Verhoeven RHA

Subjects
Aged, Esophageal Neoplasms epidemiology, Female, Humans, Male, Middle Aged, Netherlands epidemiology, Probability, Registries, Stomach Neoplasms epidemiology, Survival Analysis, Treatment Outcome, Esophageal Neoplasms therapy, Hospitals statistics & numerical data, Stomach Neoplasms therapy
Abstract

Background: Previous studies describe a large variation in the proportion of patients undergoing treatment with curative intent for esophageal (EC) and gastric cancer (GC). Since centralization of surgical care was initiated and more awareness regarding hospital practice variation was potentially present, we hypothesized that hospital practice variation for potentially curable EC and GC patients changed over time., Methods: Patients with potentially curable EC (n = 10,115) or GC (n = 3988) diagnosed between 2012-2017 were selected from the Netherlands Cancer Registry. Multilevel multivariable logistic regression was used to analyze the differences in the probability of treatment with curative intent between hospitals of diagnosis over time, comparing 2012-2014 with 2015-2017. Relative survival (RS) between hospitals with different probabilities of treatment with curative intent were compared., Results: The range of proportions of patients undergoing treatment with curative intent per hospital of diagnosis for EC was 45-95 % in 2012-2014 and 54-89 % in 2015-2017, and for GC 52-100 % and 45-100 %. The adjusted variation declined for EC with Odds Ratios ranging from 0.50 to 1.72 between centers in the first period to 0.70-1.44 in the second period (p < 0.001) and did not change for GC (Odds Ratios ranging from 0.78 to 1.23 to 0.82-1.23, (p = 1.00)). A higher probability of treatment with curative intent was associated with a better survival for both malignancies., Conclusion: Although substantial variation between hospitals of diagnosis in the probability in receiving treatment with curative intent still exists for both malignancies, it has decreased for EC. A low probability of receiving curative treatment remained associated with worse survival., (Copyright © 2021. Published by Elsevier Ltd.)

Published
2021
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3. Can We Cluster ICU Treatment Strategies for Traumatic Brain Injury by Hospital Treatment Preferences?

Author

Ceyisakar, Iris, Huijben, Jilske A., Maas, Andrew I. R., Lingsma, Hester F., van Leeuwen, Nikki, Andelic, Nada, Andreassen, Lasse, Anke, Audny Gabriele Wagner, Frisvold, Shirin, Helseth, Eirik, Røe, Cecilie, Røise, Olav, Skandsen, Toril, Vik, Anne, Åkerlund, Cecilia, Amrein, Krisztina, Antoni, Anna, Audibert, Gerard, Azouvi, Philippe, Azzolini, Maria luisa, Bartels, Ronald, Barzo, Pal, Beauvais, Romuald, Beer, Ronny, Bellander, Bo-michael, Belli, Antonio, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Blaabjerg, Morten, Bragge, Peter, Brazinova, Alexandra, Brinck, Vibeke, Brooker, Joanne, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria rosa, Cameron, Peter, Lozano, Guillermo carbayo, Carbonara, Marco, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Cnossen, Maryse, Coburn, Mark, Molecular Neuroscience and Ageing Research (MOLAR), Anke, Audny, Jones, Kelly, Karan, Mladen, Kolias, Angelos G., Kompanje, Erwin, Kondziella, Daniel, Kornaropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Antoni, Anna, Lanyon, Linda, Laureys, Steven, Lecky, Fiona, Ledoux, Didier, Lefering, Rolf, Legrand, Valerie, Lejeune, Aurelie, Levi, Leon, Lightfoot, Roger, Lingsma, Hester, Audibert, Gérard, Maas, Andrew I. R., Castaño-León, Ana M., Maegele, Marc, Majdan, Marek, Manara, Alex, Manley, Geoffrey, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Azouvi, Philippe, Melegh, Béla, Menon, David, Menovsky, Tomas, Mikolic, Ana, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Nelson, David, Newcombe, Virginia, Azzolini, Maria Luisa, Nieboer, Daan, Nyirádi, József, Olubukola, Otesile, Oresic, Matej, Ortolano, Fabrizio, Palotie, Aarno, Parizel, Paul M., Payen, Jean-François, Perera, Natascha, Perlbarg, Vincent, Bartels, Ronald, Persona, Paolo, Peul, Wilco, Piippo-Karjalainen, Anna, Pirinen, Matti, Pisica, Dana, Ples, Horia, Polinder, Suzanne, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Barzó, Pál, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rambadagalla, Malinka, Helmrich, Isabel Retel, Rhodes, Jonathan, Richardson, Sylvia, Richter, Sophie, Ripatti, Samuli, Rocka, Saulius, Beauvais, Romuald, Roe, Cecilie, Roise, Olav, Rosand, Jonathan, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Rueckert, Daniel, Rusnák, Martin, Beer, Ronny, Sahuquillo, Juan, Sakowitz, Oliver, Sanchez-Porras, Renan, Sandor, Janos, Schäfer, Nadine, Schmidt, Silke, Schoechl, Herbert, Schoonman, Guus, Schou, Rico Frederik, Schwendenwein, Elisabeth, Bellander, Bo-Michael, Sewalt, Charlie, Singh, Ranjit D., Skandsen, Toril, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stanworth, Simon, Stevens, Robert, Stewart, William, Steyerberg, Ewout W., Belli, Antonio, Stocchetti, Nino, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Taylor, Mark Steven, Ao, Braden Te, Tenovuo, Olli, Theadom, Alice, Thomas, Matt, Benali, Habib, Tibboel, Dick, Timmers, Marjolein, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Unterberg, Andreas, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Berardino, Maurizio, van der Jagt, Mathieu, Van der Steen, Gregory, van der Naalt, Joukje, van Dijck, Jeroen T. J. M., van Erp, Inge A., van Essen, Thomas A., Van Hecke, Wim, van Heugten, Caroline, Van Praag, Dominique, van Veen, Ernest, Beretta, Luigi, Vyvere, Thijs Vande, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Velt, Kimberley, Verheyden, Jan, Vespa, Paul M., Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Blaabjerg, Morten, von Steinbüchel, Nicole, Voormolen, Daphne, Vulekovic, Petar, Wang, Kevin K. W., Whitehouse, Daniel, Wiegers, Eveline, Williams, Guy, Wilson, Lindsay, Winzeck, Stefan, Wolf, Stefan, Bragge, Peter, Yang, Zhihui, Ylén, Peter, Younsi, Alexander, Zeiler, Frederick A., Zelinkova, Veronika, Ziverte, Agate, Zoerle, Tommaso, Brazinova, Alexandra, Brinck, Vibeke, Brooker, Joanne, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Carbonara, Marco, Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Citerio, Giuseppe, Clusmann, Hans, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Čović, Amra, Curry, Nicola, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, Dawes, Helen, De Keyser, Véronique, Degos, Vincent, Della Corte, Francesco, den Boogert, Hugo, Depreitere, Bart, Åkerlund, Cecilia, Đilvesi, Đula, Dixit, Abhishek, Donoghue, Emma, Dreier, Jens, Dulière, Guy-Loup, Ercole, Ari, Esser, Patrick, Ezer, Erzsébet, Fabricius, Martin, Feigin, Valery L., Amrein, Krisztina, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Gagliardo, Pablo, Galanaud, Damien, Gantner, Dashiell, Gao, Guoyi, George, Pradeep, Ghuysen, Alexandre, Giga, Lelde, Andelic, Nada, Glocker, Ben, Golubovic, Jagoš, Gomez, Pedro A., Gratz, Johannes, Gravesteijn, Benjamin, Grossi, Francesca, Gruen, Russell L., Gupta, Deepak, Haagsma, Juanita A., Haitsma, Iain, Andreassen, Lasse, Helbok, Raimund, Helseth, Eirik, Horton, Lindsay, Huijben, Jilske, Hutchinson, Peter J., Jacobs, Bram, Jankowski, Stefan, Jarrett, Mike, Jiang, Ji-yao, Johnson, Faye, Ceyisakar, I, Huijben, J, Maas, A, Lingsma, H, van Leeuwen, N, Citerio, G, Ročka, Saulius, Tamošuitis, Tomas, Ceyisakar, Iris E [0000-0002-9081-6278], Apollo - University of Cambridge Repository, Ceyisakar, Iris E, Huijben, Jilske A, Maas, Andrew I R, Lingsma, Hester F, van Leeuwen, Nikki (CENTER-TBI participants and investigators), Public Health, Neurology, Neurosurgery, Intensive Care, Pediatric Surgery, „Springer' grupė, Section Neuropsychology, RS: FPN NPPP I, and CENTER-TBI participants and investigators

Subjects
Traumatic/therapy, Neurologi, CENTER-TBI, Critical Care and Intensive Care Medicine, 01 natural sciences, Provider profiling, 010104 statistics & probability, 03 medical and health sciences, 0302 clinical medicine, Traumatic brain injury, Trauma Centers, Surveys and Questionnaires, Brain Injuries, Traumatic, MANAGEMENT, Humans, 0101 mathematics, Comparative effectiveness research, provider profiling, between-hospital variation, comparative effectiveness research, traumatic brain injury, Brain Injuries, Traumatic/therapy, Between-hospital variation, CARE, Hospitals, 3. Good health, Intensive Care Units, Neurology, Brain Injuries, Human medicine, Neurology (clinical), 030217 neurology & neurosurgery
Abstract

Neurocritical care 36(3), 846-856 (2022). doi:10.1007/s12028-021-01386-y, Published by Springer, New York, NY

Published
2022

4. Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Author

Amini, Marzyeh, den Hartog, Sanne J., van Leeuwen, Nikki, Eijkenaar, Frank, Kuhrij, Laurien S., Stolze, Lotte J., Nederkoorn, Paul J., Lingsma, Hester F., van Es, Adriaan C. G. M., van den Wijngaard, Ido R., van der Lugt, Aad, Dippel, Diederik W. J., Roozenbeek, Bob, van Zwam, Wim, van Oostenbrugge, Robert Jan, Public Health, Radiology & Nuclear Medicine, Neurology, Erasmus School of Health Policy & Management, Graduate School, ACS - Atherosclerosis & ischemic syndromes, Amsterdam Neuroscience - Neurovascular Disorders, Radiology and Nuclear Medicine, Clinical Neurophysiology, TechMed Centre, RS: Carim - B06 Imaging, RS: Carim - B05 Cerebral small vessel disease, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Neurologie (3), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, and Klinische Neurowetenschappen

Subjects
Medicine (General), INFORMATION, Medicine (miscellaneous), THERAPY, TIMES, Brain Ischemia, Feedback, Study Protocol, R5-920, DESIGN, Humans, REPERFUSION, Pharmacology (medical), Endovascular thrombectomy, METAANALYSIS, Randomized Controlled Trials as Topic, Thrombectomy, OUTCOMES, Ischemic stroke, Stepped wedge cluster randomized trial, LITERACY, Performance feedback, Quality of care, Quality Improvement, Hospitals, DISPLAYS, Stroke, AUDIT
Abstract

Background Although the provision of performance feedback to healthcare professionals based on data from quality registries is common practice in many fields of medicine, observational studies of its effect on the quality of care have shown mixed results. The objective of this study is to evaluate the effect of performance feedback on the quality of care for acute ischemic stroke. Methods PERFEQTOS is a stepped wedge cluster randomized trial in 13 hospitals in the Netherlands providing endovascular thrombectomy for ischemic stroke. The primary outcome is the hospital’s door-to-groin time. The study starts with a 6-month period in which none of the hospitals receives the performance feedback intervention. Subsequently, every 6 months, three or four hospitals are randomized to cross over from the control to the intervention conditions, until all hospitals receive the feedback intervention. The feedback intervention consists of a dashboard with quarterly reports on patient characteristics, structure, process, and outcome indicators related to patients with ischemic stroke treated with endovascular thrombectomy. Hospitals can compare their present performance with their own performance in the past and with other hospitals. The performance feedback is provided to local quality improvement teams in each hospital, who define their own targets on specific indicators and develop performance improvement plans. The impact of the performance feedback and improvement plans will be evaluated by comparing the primary outcome before and after the intervention. Discussion This study will provide evidence on the effectiveness of performance feedback to healthcare providers. The results will be actively disseminated through peer-reviewed journals, conference presentations, and various stakeholder engagement activities. Trial registration Netherlands Trial Register NL9090. Registered on December 3, 2020

Published
2021

5. Hospital Admissions, Transfers and Costs of Guillain-Barré Syndrome.

Author

van Leeuwen, Nikki, Lingsma, Hester F., Vanrolleghem, Ann M., Sturkenboom, Miriam C. J. M., van Doorn, Pieter A., Steyerberg, Ewout W., and Jacobs, Bart C.

Subjects
*GUILLAIN-Barre syndrome, *HOSPITAL admission & discharge, *MEDICAL care costs, *CURRICULUM, *INTERNAL medicine
Abstract

Background: Guillain-Barré syndrome (GBS) has a highly variable clinical course, leading to frequent transfers within and between hospitals and high associated costs. We defined the current admissions, transfers and costs in relation to disease severity of GBS. Methods: Dutch neurologists were requested to report patients diagnosed with GBS between November 2009 and November 2010. Information regarding clinical course and transfers was obtained via neurologists and general practitioners. Results: 87 GBS patients were included with maximal GBS disability score of 1 or 2 (28%), 3 or 4 (53%), 5 (18%) and 6 (1%). Four mildly affected GBS patients were not hospital admitted. Of the 83 hospitalized patients 68 (82%) were initially admitted at a neurology department, 4 (5%) at an ICU, 4 (5%) at pediatrics, 4 (5%) at pediatrics neurology and 3 (4%) at internal medicine. Median hospital stay was 17 days (IQR 11–26 days, absolute range 1–133 days). Transfers between departments or hospitals occurred in 33 (40%) patients and 25 (30%) were transferred 2 times or more. From a cost-effectiveness perspective 21 (25%) of the admissions was suboptimal. Median costs for hospital admission of GBS patients were 15,060 Euro (IQR 11,226–23,683). Maximal GBS disability score was significantly correlated with total length of stay, number of transfers, ICU admission and costs. Conclusions: Hospital admissions for GBS patients are highly heterogeneous, with frequent transfers and higher costs for those with more severe disease. Future research should aim to develop prediction models to early identify the most cost-effective allocation in individual patients. [ABSTRACT FROM AUTHOR]

Published
2016
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