Observational studyJournal of general internal medicine2020
Identifying Performance Outliers for Stroke Care Based on Composite Score of Process Indicators: an Observational Study in China.
Observational study in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Methods to derive composite indicators used for quality and safety measurement and monitoring in healthcare: a scoping review.Frontiers in health services · 2026Pooled it
- Accuracy of site benchmarking in clinical quality registries of varying size.Health information management : journal of the Health Information Management Association of Australia · 2026Article
- Trends in care quality in China from 2011 to 2017: An analysis based on the National Specific (Single) Disease Monitoring System.Journal of global health · 2023Article
- Composite measures of quality of health care: Evidence mapping of methodology and reporting.PloS one · 2022Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVariability in the quality of stroke care is widespread. Identifying performance-based outlier hospitals based on quality indicators (QIs) has become a common practice.
objectivesTo develop a tool for identifying performance-based outlier hospitals based on risk-adjusted adherence rates of process indicators.
designHospitals were classified into five-level outliers based on the observed-to-expected ratio and P value. The composite quality score was derived by summation of the points for each indicator for each hospital, and associations between outlier status and outcomes were determined.
participantsPatients diagnosed with acute ischemic stroke, January 1, 2011-May 31, 2017.
interventionN/A
main outcome measuresIndependence at discharge (the modified Rankin Scale = 0-2). KEY
resultsA total of 501,132 patients from 519 hospitals were identified. From 0.39 to 19.65% of hospitals were identified as high outliers according to various QIs. Composite quality scores ranged from - 20 to 16. Providers that were high outliers based on QI2, QI8, QI9, and QI11 had higher independent rates. For composite quality score, each point increase corresponded to an 8% increase in the odds of independent rate.
conclusionNationwide variation in the quality of acute stroke care exists at the hospital level. Variability in the quality of stroke care can be captured by our proposed quality score. Applying this quality score as a benchmarking tool could provide audit-level feedback to policymakers and hospitals to aid quality improvement.
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