Observational studyBMC health services research2020
Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough.
Observational study in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Quality indicators for structure and process in peri-operative care: a systematic review.Anaesthesia · 2026Pooled it
- Validity of Early Outcomes as Indicators for Comparing Hospitals on Quality of Stroke Care.Journal of the American Heart Association · 2023Trial
- Patient outcomes and healthcare utilisation following implementation of an advanced therapy care pathway for inflammatory bowel disease: a multicentre, prospective quasi-experimental preimplementation/postimplementation study in the Netherlands.BMJ open gastroenterology · 2026Article
- Evaluating the Effectiveness of Targeted Interventions on the Quality of Life for Patients with Ischemic Stroke.Global journal on quality and safety in healthcare · 2025Article
- Reporting feedback on healthcare outcomes to improve quality in care: a scoping review.Implementation science : IS · 2025Article
- Variations in Out-of-Hospital Cardiac Arrest Resuscitation Performance and Outcomes in Ohio.The western journal of emergency medicine · 2025Article
- Variation Between Hospitals in Outcomes and Costs of IBD Care: Results From the IBD Value Study.Inflammatory bowel diseases · 2025Article
- Differences between centers in functional outcome of patients with ADHD after 1 year from the time of diagnosis.Scientific reports · 2023Observational
- Multicentric validation of a reduced features case-mix set for predicting functional outcome after ischemic stroke in Belgium.Acta neurologica Belgica · 2023Article
- Estimation of treatment effects in observational stroke care data: comparison of statistical approaches.BMC medical research methodology · 2022Observational
- Article
- Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study.Critical care (London, England) · 2021Article
Corrections and comments
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBetween-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.
methodsIn 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 tau
resultsThree thousand two hundred seventy-nine patients were included. Performance on structure and process indicators varied significantly between EVT-centers (P < 0.001). Predicted probability of good functional outcome (modified Rankin Scale 0-2 at 90 days), which can be interpreted as an overall measure of a center's case-mix, varied significantly between 17 and 50% across centers. The amount of between-center variation (tau
conclusionsBetween-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.
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