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4 results on '"van Leeuwen, Nikki"'

1. Standardized mortality ratios for regionalized acute cardiovascular care.

Author

den Hartog, Sanne J., Roozenbeek, Bob, van der Bij, Sjoukje, Amini, Marzyeh, van Leeuwen, Nikki, Boersma, Eric, Dirven, Clemens M.F., Dippel, Diederik W.J., and Lingsma, Hester F.

Subjects
HOSPITAL mortality, MYOCARDIAL infarction, HOSPITAL care quality, RATINGS of hospitals, HOSPITAL care, CEREBROVASCULAR disease, REGIONALISM (International organization)
Abstract

Background: Standardized Mortality Ratios (SMRs) are case-mix adjusted mortality rates per hospital and are used to evaluate quality of care. However, acute care is increasingly organized on a regional level, with more severe patients admitted to specialized hospitals. We hypothesize that the current case-mix adjustment insufficiently captures differences in case-mix between non-specialized and specialized hospitals. We aim to improve the SMR by adding proxies of disease severity to the model and by calculating a regional SMR (RSMR) for acute cerebrovascular disease (CVD) and myocardial infarction (MI). Methods: We used data from the Dutch National Basic Registration of Hospital Care. We selected all admissions from 2016 to 2018. SMRs and RSMRs were calculated by dividing the observed in-hospital mortality by the expected in-hospital mortality. The expected in-hospital mortality was calculated using logistic regression with adjustment for age, sex, socioeconomic status, severity of main diagnosis, urgency of admission, Charlson comorbidity index, place of residence before admission, month/year of admission, and in-hospital mortality as outcome. Results: The IQR of hospital SMRs of CVD was 0.85–1.10, median 0.94, with higher SMRs for specialized hospitals (median 1.12, IQR 1.00-1.28, 71%-SMR > 1) than for non-specialized hospitals (median 0.92, IQR 0.82–1.07, 32%-SMR > 1). The IQR of RSMRs was 0.92–1.09, median 1.00. The IQR of hospital SMRs of MI was 0.76–1.14, median 0.98, with higher SMRs for specialized hospitals (median 1.00, IQR 0.89–1.25, 50%-SMR > 1 versus median 0.94, IQR 0.74–1.11, 44%-SMR > 1). The IQR of RSMRs was 0.90–1.08, median 1.00. Adjustment for proxies of disease severity mostly led to lower SMRs of specialized hospitals. Conclusion: SMRs of acute regionally organized diseases do not only measure differences in quality of care between hospitals, but merely measure differences in case-mix between hospitals. Although the addition of proxies of disease severity improves the model to calculate SMRs, real disease severity scores would be preferred. However, such scores are not available in administrative data. As a consequence, the usefulness of the current SMR as quality indicator is very limited. RSMRs are potentially more useful, since they fit regional organization and might be a more valid representation of quality of care. [ABSTRACT FROM AUTHOR]

Published
2023
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2. 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

3. Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough

Author

Amini, Marzyeh, van Leeuwen, Nikki, Eijkenaar, Frank, Mulder, Maxim J. H. L., Schonewille, Wouter, Nijeholt, Geert Lycklama a, Hinsenveld, Wouter H., Goldhoorn, Robert-Jan B., van Doormaal, Pieter Jan, Jenniskens, Sjoerd, Hazelzet, Jan, Dippel, Diederik W. J., Roozenbeek, Bob, Lingsma, Hester F., van Zwam, Wim, Clinical Neurophysiology, TechMed Centre, Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, Neurology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, ACS - Pulmonary hypertension & thrombosis, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ARD - Amsterdam Reproduction and Development, AMS - Amsterdam Movement Sciences, Biomedical Engineering and Physics, Adult Psychiatry, APH - Methodology, Public Health, Erasmus School of Health Policy & Management, Radiology & Nuclear Medicine, Klinische Neurowetenschappen, RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Niet Med Staf Neurologie (9), RS: Carim - B06 Imaging, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), Radiology and nuclear medicine, Amsterdam Neuroscience - Neurovascular Disorders, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), and Damage and Repair in Cancer Development and Cancer Treatment (DARE)

Subjects
Male, Quality management, Outcome (game theory), THERAPY, Cohort Studies, 03 medical and health sciences, GENERAL-ANESTHESIA, 0302 clinical medicine, Case mix index, All institutes and research themes of the Radboud University Medical Center, CONSCIOUS SEDATION, Modified Rankin Scale, medicine, IMPUTATION, MANAGEMENT, Case-mix, Humans, REPERFUSION, Endovascular treatment, 030212 general & internal medicine, ACUTE ISCHEMIC-STROKE, Stroke, Aged, Aged, 80 and over, business.industry, Health Policy, lcsh:Public aspects of medicine, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Quality of care, lcsh:RA1-1270, Middle Aged, Random effects model, medicine.disease, Quality Improvement, ENDOVASCULAR THROMBECTOMY, Benchmarking, Variation (linguistics), Treatment Outcome, HOSPITAL VOLUME, Outcome differences, OF-CARE, Process of care, Female, business, 030217 neurology & neurosurgery, Demography, Cohort study, Research Article
Abstract

Background Between-center variation in outcome may offer opportunities to identify variation in quality of care. By intervening on these quality differences, patient outcomes may be improved. However, whether observed differences in outcome reflect the true quality improvement potential is not known for many diseases. Therefore, we aimed to analyze the effect of differences in performance on structure and processes of care, and case-mix on between-center differences in outcome after endovascular treatment (EVT) for ischemic stroke. Methods In this observational cohort study, ischemic stroke patients who received EVT between 2014 and 2017 in all 17 Dutch EVT-centers were included. Primary outcome was the modified Rankin Scale, ranging from 0 (no symptoms) to 6 (death), at 90 days. We used random effect proportional odds regression modelling, to analyze the effect of differences in structure indicators (center volume and year of admission), process indicators (time to treatment and use of general anesthesia) and case-mix, by tracking changes in tau2, which represents the amount of between-center variation in outcome. Results Three thousand two hundred seventy-nine patients were included. Performance on structure and process indicators varied significantly between EVT-centers (P tau2) was estimated at 0.040 in a model only accounting for random variation. This estimate more than doubled after adding case-mix variables (tau2: 0.086) to the model, while a small amount of between-center variation was explained by variation in performance on structure and process indicators (tau2: 0.081 and 0.089, respectively). This indicates that variation in case-mix affects the differences in outcome to a much larger extent. Conclusions Between-center variation in outcome of ischemic stroke patients mostly reflects differences in case-mix, rather than differences in structure or process of care. Since the latter two capture the real quality improvement potential, these should be used as indicators for comparing center performance. Especially when a strong association exists between those indicators and outcome, as is the case for time to treatment in ischemic stroke.

Published
2020

4. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

Author

Huijben, Jilske A., Wiegers, Eveline J. A., Polinder, Suzanne, Steyerberg, Ewout W., van der Jagt, Mathieu, Lingsma, Hester F., Delphi panel, Aries, Marcel, Badenes, Rafael, Beishuizen, Albertus, Bilotta, Federico, Chieregato, Arturo, de Keizer, Nicolette F., Cingolani, Emiliano, Citerio, Giuseppe, Cnossen, Maryse, Coburn, Mark, Coles, Jonathan P., Delargy, Mark, Depreitere, Bart, Ercole, Ari, Flaatten, Hans, Golyk, Volodymyr, Maas, Andrew I. R., Grauwmeijer, Erik, Haitsma, Iain, Helbok, Raimund, Hoedemaekers, Cornelia, Jacobs, Bram, Jellema, Korné, Koskinen, Lars-Owe D., Maegele, Marc, Delgado, Maria Cruz Martin, Menon, David, Møller, Kirsten, Moreno, Rui, Nelson, David, Oldenbeuving, Annemarie W., Payen, Jean-Francois, Pejakovic, Jasmina, Ribbbers, Gerard M., Rossaint, Rolf, Schoonman, Guus Geurt, Steiner, Luzius A., Stocchetti, Nino, Taccone, Fabio Silvio, Takala, Riikka, Tenovuo, Olli, Valeinis, Eglis, van den Bergh, Walter M., van Essen, Thomas, van Leeuwen, Nikki, Verhofstad, Michael H. J., Vos, Pieter E., Wilson, Lindsay, Lecky, Fiona, Cnossen, Maryse C., Delphi Panel, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Intensive Care, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Medische Staf IC (9), Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Huijben, J, Wiegers, E, de Keizer, N, Maas, A, Menon, D, Ercole, A, Citerio, G, Lecky, F, Wilson, L, Cnossen, M, Polinder, S, Steyerberg, E, van der Jagt, M, Lingsma, H, Medical Informatics, APH - Methodology, APH - Quality of Care, APH - Digital Health, Public Health, Rehabilitation Medicine, Neurosurgery, and Surgery

Subjects
Quality management, NEUROTRAUMA EFFECTIVENESS RESEARCH, Delphi Technique, Quality indicator, Delphi method, CHILDREN, Quality indicators, Critical Care and Intensive Care Medicine, GUIDELINES, law.invention, 0302 clinical medicine, Traumatic brain injury, law, Surveys and Questionnaires, Brain Injuries, Traumatic, Medicine, Registries, media_common, computer.programming_language, OUTCOMES, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Trauma registry, Benchmarking, Intensive care unit, Quality Improvement, 3. Good health, Europe, Intensive Care Units, HOSPITAL-CARE, OF-CARE, Medical emergency, Life Sciences & Biomedicine, Anestesi och intensivvård, media_common.quotation_subject, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Likert scale, 03 medical and health sciences, ADHERENCE, Critical Care Medicine, Intensive care, General & Internal Medicine, Quality indicators, Benchmarking, Traumatic brain injury, Intensive care unit, Trauma registry, Quality of care, MANAGEMENT, Humans, Quality (business), VALIDITY, Expert Testimony, Quality Indicators, Health Care, Quality of Health Care, Quality care, Science & Technology, Anesthesiology and Intensive Care, business.industry, Research, Quality of care, 030208 emergency & critical care medicine, lcsh:RC86-88.9, medicine.disease, Human medicine, business, computer, Delphi
Abstract

Background We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future. Electronic supplementary material The online version of this article (10.1186/s13054-019-2377-x) contains supplementary material, which is available to authorized users.

Published
2019

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