Evidence map›Paper›PMID 31805876›Full record

ArticleBMC medical research methodology2019

Value-based healthcare in ischemic stroke care: case-mix adjustment models for clinical and patient-reported outcomes.

Arvind Oemrawsingh, Nikki van Leeuwen, Esmee Venema, Martien Limburg, Frank-Erik de Leeuw, Markus P Wijffels, Aafke J de Groot, Pieter H E Hilkens, Jan A Hazelzet, Diederik W J Dippel and 3 more

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In one paragraph

Article in BMC medical research methodology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 2 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Arvind OemrawsinghCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. a.oemrawsingh@erasmusmc.nl.
Nikki van LeeuwenCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Esmee VenemaCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Martien LimburgDepartment of Neurology, Flevoziekenhuis, Almere, the Netherlands.
Frank-Erik de LeeuwDepartment of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
Markus P WijffelsDepartment of Neurorehabilitation, Rijndam Rehabilitation, Rotterdam, the Netherlands.
Aafke J de GrootDepartment of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands / Vivium Naarderheem, Naarden, the Netherlands.
Pieter H E HilkensDepartment of Neurology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Jan A HazelzetCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.
Diederik W J DippelDepartment of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Carla H BakkerExpert Centre Quality Registries, Leiden University Medical Center, Leiden, the Netherlands.
Helene R Voogdt-PruisStroke Knowledge Network Netherlands, Utrecht, the Netherlands.
Hester F LingsmaCenter for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPatient-Reported Outcome Measures (PROMs) have been proposed for benchmarking health care quality across hospitals, which requires extensive case-mix adjustment. The current study's aim was to develop and compare case-mix models for mortality, a functional outcome, and a patient-reported outcome measure (PROM) in ischemic stroke care.

methodsData from ischemic stroke patients, admitted to four stroke centers in the Netherlands between 2014 and 2016 with available outcome information (N = 1022), was analyzed. Case-mix adjustment models were developed for mortality, modified Rankin Scale (mRS) scores and EQ-5D index scores with respectively binary logistic, proportional odds and linear regression models with stepwise backward selection. Predictive ability of these models was determined with R-squared (R

resultsAge, NIHSS score on admission, and heart failure were the only common predictors across all three case-mix adjustment models. Specific predictors for the EQ-5D index score were sex (β = 0.041), socio-economic status (β = - 0.019) and nationality (β = - 0.074). R

conclusionsThe set of case-mix adjustment variables for the EQ-5D at three months differed considerably from the set for clinical outcomes in stroke care. The case-mix adjustment variables that were specific to this PROM were sex, socio-economic status and nationality. These variables should be considered in future attempts to risk-adjust for PROMs during benchmarking of hospitals.

Indexed as

Patient Reported Outcome MeasuresRisk AdjustmentAgedAged, 80 and overBrain IschemiaFemaleHumansLinear ModelsMaleMiddle AgedOdds RatioPredictive Value of TestsRecovery of FunctionROC CurveStrokeSurvival RateCase-mixIschemic strokePatient-reported outcome measureRisk adjustment modelValue-based healthcare

Identifiers

PMID31805876
PMCPMC6896707

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.