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Ryan O, Ghuliani J, Grabsch B, Hill K, C Cloud G, Breen S, Kilkenny MF, Cadilhac DA. Development, implementation, and evaluation of the Australian Stroke Data Tool (AuSDaT): Comprehensive data capturing for multiple uses. HEALTH INF MANAG J 2024; 53:85-93. [PMID: 36305638 DOI: 10.1177/18333583221117184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Historically, national programs for collecting stroke data in Australia required the use of multiple online tools. Clinicians were required to enter overlapping variables for the same patient in the different databases. From 2013 to 2016, the Australian Stroke Data Tool (AuSDaT) was built as an integrated data management solution. OBJECTIVE In this article, we have described the development, implementation, and evaluation phases of establishing the AuSDaT. METHOD In the development phase, a governance structure with representatives from different data collection programs was established. Harmonisation of data variables, drawn from six programs used in hospitals for monitoring stroke care, was facilitated through creating a National Stroke Data Dictionary. The implementation phase involved a staged deployment for two national programs over 12 months. The evaluation included an online survey of people who had used the AuSDaT between March 2018 and May 2018. RESULTS By July 2016, data entered for an individual patient was, for the first time, shared between national programs. Overall, 119/422 users (90% female, 61% aged 30-49 years, 57% nurses) completed the online evaluation survey. The two most positive features reported about the AuSDaT were (i) accessibility of the system (including simultaneous user access), and (ii) the ability to download reports to benchmark local data against peer hospitals or national performance. More than three quarters of respondents (n = 92, 77%) reported overall satisfaction with the data collection tool. CONCLUSION The AuSDaT reduces duplication and enables users from different national programs for stroke to enter standardised data into a single system. IMPLICATIONS This example may assist others who seek to establish a harmonised data management solution for different disease areas where multiple programs of data collection exist. The importance of undertaking continuous evaluation of end-users to identify preferences and aspects of the tool that are not meeting current requirements were illustrated. We also highlighted the opportunities to increase interoperability, utility, and facilitate the exchange of accurate and meaningful data.
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Affiliation(s)
- Olivia Ryan
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Jot Ghuliani
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Brenda Grabsch
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC, Australia
| | - Geoffrey C Cloud
- Department of Neurology, Alfred Hospital, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, VIC, Australia
| | - Sibilah Breen
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Monique F Kilkenny
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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Parker KJ, Hickman LD, McDonagh J, Lindley RI, Ferguson C. The prototype of a frailty learning health system: The HARMONY Model. Learn Health Syst 2024; 8:e10401. [PMID: 38633027 PMCID: PMC11019377 DOI: 10.1002/lrh2.10401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 04/19/2024] Open
Abstract
Introduction Rapid translation of research findings into clinical practice through innovation is critical to improve health systems and patient outcomes. Access to efficient systems of learning underpinned with real-time data are the future of healthcare. This type of health system will decrease unwarranted clinical variation, accelerate rapid evidence translation, and improve overall healthcare quality. Methods This paper aims to describe The HARMONY model (acHieving dAta-dRiven quality iMprovement to enhance frailty Outcomes using a learNing health sYstem), a new frailty learning health system model of implementation science and practice improvement. The HARMONY model provides a prototype for clinical quality registry infrastructure and partnership within health care. Results The HARMONY model was applied to the Western Sydney Clinical Frailty Registry as the prototype exemplar. The model networks longitudinal frailty data into an accessible and useable format for learning. Creating local capability that networks current data infrastructures to translate and improve quality of care in real-time. Conclusion This prototype provides a model of registry data feedback and quality improvement processes in an inpatient aged care and rehabilitation hospital setting to help reduce clinical variation, enhance research translation capacity, and improve care quality.
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Affiliation(s)
- Kirsten J. Parker
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNew South WalesAustralia
- Centre for Chronic and Complex Care ResearchBlacktown HospitalWestern Sydney Local Health DistrictBlacktownNew South WalesAustralia
| | | | - Julee McDonagh
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNew South WalesAustralia
- Centre for Chronic and Complex Care ResearchBlacktown HospitalWestern Sydney Local Health DistrictBlacktownNew South WalesAustralia
| | - Richard I. Lindley
- Centre for Chronic and Complex Care ResearchBlacktown HospitalWestern Sydney Local Health DistrictBlacktownNew South WalesAustralia
- Westmead Applied Research CentreUniversity of SydneyWestmeadNew South WalesAustralia
| | - Caleb Ferguson
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNew South WalesAustralia
- Centre for Chronic and Complex Care ResearchBlacktown HospitalWestern Sydney Local Health DistrictBlacktownNew South WalesAustralia
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Fasugba O, Sedani R, Mikulik R, Dale S, Vařecha M, Coughlan K, McElduff B, McInnes E, Hladíková S, Cadilhac DA, Middleton S. How registry data are used to inform activities for stroke care quality improvement across 55 countries: A cross-sectional survey of Registry of Stroke Care Quality (RES-Q) hospitals. Eur J Neurol 2024; 31:e16024. [PMID: 37540834 PMCID: PMC10952746 DOI: 10.1111/ene.16024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND AND PURPOSE The Registry of Stroke Care Quality (RES-Q) is a worldwide quality improvement data platform that captures performance and quality measures, enabling standardized comparisons of hospital care. The aim of this study was to determine if, and how, RES-Q data are used to influence stroke quality improvement and identify the support and educational needs of clinicians using RES-Q data to improve stroke care. METHODS A cross-sectional self-administered online survey was administered (October 2021-February 2022). Participants were RES-Q hospital local coordinators responsible for stroke data collection. Descriptive statistics are presented. RESULTS Surveys were sent to 1463 hospitals in 74 countries; responses were received from 358 hospitals in 55 countries (response rate 25%). RES-Q data were used "always" or "often" to: develop quality improvement initiatives (n = 213, 60%); track stroke care quality over time (n = 207, 58%); improve local practice (n = 191, 53%); and benchmark against evidence-based policies, procedures and/or guidelines to identify practice gaps (n = 179, 50%). Formal training in the use of RES-Q tools and data were the most frequent support needs identified by respondents (n = 165, 46%). Over half "strongly agreed" or "agreed" that to support clinical practice change, education is needed on: (i) using data to identify evidence-practice gaps (n = 259, 72%) and change clinical practice (n = 263, 74%), and (ii) quality improvement science and methods (n = 255, 71%). CONCLUSION RES-Q data are used for monitoring stroke care performance. However, to facilitate their optimal use, effective quality improvement methods are needed. Educating staff in quality improvement science may develop competency and improve use of data in practice.
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Affiliation(s)
- Oyebola Fasugba
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Rupal Sedani
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Robert Mikulik
- International Clinical Research Centre, Neurology DepartmentSt. Anne's University Hospital and Masaryk UniversityBrnoCzech Republic
| | - Simeon Dale
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Miroslav Vařecha
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Kelly Coughlan
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
| | - Sabina Hladíková
- International Clinical Research CentreSt. Anne's University HospitalBrnoCzech Republic
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
- Stroke Theme, Florey Institute of Neuroscience and Mental HealthUniversity of MelbourneHeidelbergVictoriaAustralia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network SydneySt Vincent's Hospital Melbourne and Australian Catholic UniversitySydneyNew South WalesAustralia
- School of Nursing, Midwifery and ParamedicineAustralian Catholic UniversitySydneyNew South WalesAustralia
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Tian W, Zhu G, Xiao W, Gao B, Lu W, Wang Y. Stroke burden and attributable risk factors in China, 1990-2019. Front Neurol 2023; 14:1193056. [PMID: 37292127 PMCID: PMC10245554 DOI: 10.3389/fneur.2023.1193056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/03/2023] [Indexed: 06/10/2023] Open
Abstract
Background and purpose Understanding the temporal trends of stroke burden and its attributable risk factors are essential for targeted prevention strategies. We aimed to describe the temporal trends and attributable risk factors of stroke in China. Methods Data on the stroke burden [incidence, prevalence, mortality, and disability-adjusted life years (DALYs)] and the population-attributable fraction for stroke risk factors from 1990 to 2019 were obtained from the Global Burden of Disease Study 2019 (GBD 2019). We analyzed trends in the burden of stroke and its attributable risk factors from 1990 to 2019, and the characteristics of stroke-attributable risk factors by sex, age group, and stroke subtype. Results From 1990 to 2019, the age-standardized incidence, mortality, and DALY rates for total stroke decreased by 9.3% (3.3, 15.5), 39.8% (28.6, 50.7), and 41.6% (30.7, 50.9) respectively. The corresponding indicators all decreased for intracerebral hemorrhage and subarachnoid hemorrhage. The age-standardized incidence rate of ischemic stroke increased by 39.5% (33.5 to 46.2) for male patients and by 31.4% (24.7 to 37.7) for female patients, and the age-standardized mortality and DALY rates remained almost unchanged. The three leading stroke risk factors were high systolic blood pressure, ambient particulate matter pollution, and smoking. High systolic blood pressure has remained the leading risk factor since 1990. The attributable risk of ambient particulate matter pollution shows a clear upward trend. Smoking and alcohol consumption were important risk factors for men. Conclusion This study reinforced the findings of an increased stroke burden in China. Precise stroke prevention strategies are needed to reduce the disease burden of stroke.
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Affiliation(s)
- Wenxin Tian
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Guanghan Zhu
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Wenbo Xiao
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Bei Gao
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Wenli Lu
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
| | - Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
- Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Heping District, Tianjin, China
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Cadilhac DA, Bravata DM, Bettger JP, Mikulik R, Norrving B, Uvere EO, Owolabi M, Ranta A, Kilkenny MF. Stroke Learning Health Systems: A Topical Narrative Review With Case Examples. Stroke 2023; 54:1148-1159. [PMID: 36715006 PMCID: PMC10050099 DOI: 10.1161/strokeaha.122.036216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To our knowledge, the adoption of Learning Health System (LHS) concepts or approaches for improving stroke care, patient outcomes, and value have not previously been summarized. This topical review provides a summary of the published evidence about LHSs applied to stroke, and case examples applied to different aspects of stroke care from high and low-to-middle income countries. Our attempt to systematically identify the relevant literature and obtain real-world examples demonstrated the dissemination gaps, the lack of learning and action for many of the related LHS concepts across the continuum of care but also elucidated the opportunity for continued dialogue on how to study and scale LHS advances. In the field of stroke, we found only a few published examples of LHSs and health systems globally implementing some selected LHS concepts, but the term is not common. A major barrier to identifying relevant LHS examples in stroke may be the lack of an agreed taxonomy or terminology for classification. We acknowledge that health service delivery settings that leverage many of the LHS concepts do so operationally and the lessons learned are not shared in peer-reviewed literature. It is likely that this topical review will further stimulate the stroke community to disseminate related activities and use keywords such as learning health system so that the evidence base can be more readily identified.
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Affiliation(s)
- Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (D.A.C., M.F.K.)
| | - Dawn M Bravata
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN (D.M.B.)
- Departments of Medicine and Neurology, Indiana University School of Medicine, Indianapolis (D.M.B.)
- Regenstrief Institute, Indianapolis, IN (D.M.B.)
| | - Janet Prvu Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA (J.P.B.)
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St. Ann's University Hospital and Masaryk University, Brno, Czech Republic (R.M.)
- Health Management Institute, Czech Republic (R.M.)
| | - Bo Norrving
- Lund University, Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Sweden (B.N.)
| | - Ezinne O Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria (E.O.U., M.O.)
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria (E.O.U., M.O.)
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand (A.R.)
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (D.A.C., M.F.K.)
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (D.A.C., M.F.K.)
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Bam K, Olaiya MT, Cadilhac DA, Donnan GA, Murphy L, Kilkenny MF. Enhancing primary stroke prevention: a combination approach. THE LANCET PUBLIC HEALTH 2022; 7:e721-e724. [DOI: 10.1016/s2468-2667(22)00156-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/13/2023] Open
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Quality of Care and Outcomes for Patients with Acute Ischemic Stroke and Transient Ischemic Attack During the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2022; 31:106455. [PMID: 35395471 PMCID: PMC8983051 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose Hospitalizations for acute ischemic stroke (AIS) and transient ischemic attack (TIA) decreased during the COVID-19 pandemic. We compared the quality of care and outcomes for patients with AIS/TIA before vs. during the COVID-19 pandemic across the United States Department of Veterans Affairs healthcare system. Methods This retrospective cohort study compared AIS/TIA care quality before (March–September 2019) vs. during (March-September 2020) the pandemic. Electronic health record data were used to identify patient characteristics, quality of care and outcomes. The without-fail rate was a composite measure summarizing whether an individual patient received all of the seven processes for which they were eligible. Mixed effects logistic regression modeling was used to assess differences between the two periods. Results A decrease in presentations occurred during the pandemic (N = 4360 vs. N = 5636 patients; p = 0.003) and was greater for patients with TIA (-30.4%) than for AIS (-18.7%). The without-fail rate improved during the pandemic (56.2 vs. before 50.1%). The use of high/moderate potency statins increased among AIS patients (OR 1.26 [1.06–1.48]) and remained unchanged among those with TIA (OR 1.04 [0.83,1.29]). Blood pressure measurement within 90-days of discharge was less frequent during the pandemic (57.8 vs. 89.2%, p < 0.001). Hypertension control decreased among patients with AIS (OR 0.73 [0.60–0.90]) and TIA (OR 0.72 [0.54-0.96]). The average systolic and diastolic blood pressure was 1.9/1.4 mmHg higher during the pandemic than before (p < 0.001). Compared to before, during the pandemic fewer AIS patients had a primary care visit (52.5% vs. 79.8%; p = 0.0001) or a neurology visit (27.9 vs. 41.1%; p = 0.085). Both 30- and 90-day unadjusted all-cause mortality rates were higher in 2020 (3.6% and 6.7%) vs. 2019 (2.9, 5.4%; p = 0.041 and p = 0.006); but these differences were not statistically significant after risk adjustment. Conclusions Overall quality of care for patients with AIS/TIA did not decline during the COVID-19 pandemic.
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Amini M, den Hartog SJ, van Leeuwen N, Eijkenaar F, Kuhrij LS, Stolze LJ, Nederkoorn PJ, Lingsma HF, van Es ACGM, van den Wijngaard IR, van der Lugt A, Dippel DWJ, Roozenbeek B. Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial. Trials 2021; 22:870. [PMID: 34863254 PMCID: PMC8643025 DOI: 10.1186/s13063-021-05819-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/12/2021] [Indexed: 01/04/2023] Open
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 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05819-z.
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Affiliation(s)
- Marzyeh Amini
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sanne J den Hartog
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Eijkenaar
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Laurien S Kuhrij
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Lotte J Stolze
- Dutch Institute for Clinical Auditing, Leiden, The Netherlands.,Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Adriaan C G M van Es
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ido R van den Wijngaard
- Department of Neurology, Haaglanden Medical Center, the Hague, The Netherlands.,Department of Radiology, Haaglanden Medical Center, the Hague, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bob Roozenbeek
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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