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Development of Quality Indicators of Stroke Centers and Feasibility of Their Measurement Using a Nationwide Insurance Claims Database in Japan ― J-ASPECT Study ―
- Source :
-
Circulation journal : official journal of the Japanese Circulation Society [Circ J] 2019 Oct 25; Vol. 83 (11), pp. 2292-2302. Date of Electronic Publication: 2019 Sep 26. - Publication Year :
- 2019
-
Abstract
- Background: We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database.<br />Methods and results: We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013-2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6% and 58.7%; discharge anticoagulation for atrial fibrillation, 64.4%; discharge antihypertensive agents, 51.7%; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9%; death complications of diagnostic neuroangiography, 0.4%). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics.<br />Conclusions: We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.
- Subjects :
- Aged
Aged, 80 and over
Databases, Factual
Delphi Technique
Feasibility Studies
Female
Guideline Adherence standards
Healthcare Disparities standards
Humans
Japan
Male
Middle Aged
Practice Guidelines as Topic standards
Quality Improvement standards
Risk Factors
Stroke diagnosis
Stroke mortality
Time Factors
Treatment Outcome
Administrative Claims, Healthcare
Comprehensive Health Care standards
Delivery of Health Care, Integrated standards
Outcome and Process Assessment, Health Care standards
Practice Patterns, Physicians' standards
Quality Indicators, Health Care standards
Stroke therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1347-4820
- Volume :
- 83
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Circulation journal : official journal of the Japanese Circulation Society
- Publication Type :
- Academic Journal
- Accession number :
- 31554766
- Full Text :
- https://doi.org/10.1253/circj.CJ-19-0089