Evidence map›Paper›PMID 37126821›Full record

ArticleAnnals of internal medicine2023

Prioritizing Quality Measures in Acute Stroke Care : A Cost-Effectiveness Analysis.

Jinyi Zhu, Hooman Kamel, Ajay Gupta, Alvin I Mushlin, Nicolas A Menzies, Thomas A Gaziano, Meredith B Rosenthal, Ankur Pandya

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–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

7 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
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

8 authors.

Jinyi ZhuDepartment of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee (J.Z.).ORCID 0000-0001-8169-5956
Hooman KamelClinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, and Department of Neurology, Weill Cornell Medicine, New York, New York (H.K.).
Ajay GuptaDepartment of Radiology, Weill Cornell Medicine, New York, New York (A.G.).
Alvin I MushlinDepartments of Population Health Sciences and Medicine, Weill Cornell Medical College, New York, New York (A.I.M.).ORCID 0000-0002-9298-9084
Nicolas A MenziesCenter for Health Decision Science and Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (N.A.M.).ORCID 0000-0002-2571-016X
Thomas A GazianoCenter for Health Decision Science, Harvard T.H. Chan School of Public Health, and Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (T.A.G.).
Meredith B RosenthalDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (M.B.R.).ORCID 0000-0003-3410-0184
Ankur PandyaCenter for Health Decision Science and Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (A.P.).

Funding

Development, Validation, and Application of a Stroke Policy Simulation ModelR01NS104143 · NINDS · HARVARD SCHOOL OF PUBLIC HEALTH · PI PANDYA, ANKUR · 2018 to 2022
$2.3M
NINDS NIH HHS R01 NS104143
6 · The paper itself

Abstract

backgroundThe American Heart Association and American Stroke Association (AHA/ASA) endorsed 15 process measures for acute ischemic stroke (AIS) to improve the quality of care. Identifying the highest-value measures could reduce the administrative burden of quality measure adoption while retaining much of the value of quality improvement.

objectiveTo prioritize AHA/ASA-endorsed quality measures for AIS on the basis of health impact and cost-effectiveness.

designIndividual-based stroke simulation model. DATA SOURCES: Published literature. TARGET POPULATION: U.S. patients with incident AIS. TIME HORIZON: Lifetime. PERSPECTIVE: Health care sector.

interventionCurrent versus complete (100%) implementation at the population level of quality measures endorsed by the AHA/ASA with sufficient clinical evidence (10 of 15). OUTCOME MEASURES: Life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and incremental net health benefits. RESULTS OF BASE-CASE ANALYSIS: Discounted life-years gained from complete implementation would range from 472 (tobacco use counseling) to 34 688 (early carotid imaging) for an annual AIS patient cohort. All AIS quality measures were cost-saving or highly cost-effective by AHA standards (<$50 000 per QALY for high-value care). Early carotid imaging and intravenous tissue plasminogen activator contributed the largest fraction of the total potential value of quality improvement (measured as incremental net health benefit), accounting for 72% of the total value. The top 5 quality measures accounted for 92% of the total potential value. RESULTS OF SENSITIVITY ANALYSIS: A web-based user interface allows for context-specific sensitivity and scenario analyses. LIMITATION: Correlations between quality measures were not incorporated.

conclusionSubstantial variation exists in the potential net benefit of quality improvement across AIS quality measures. Benefits were highly concentrated among 5 of 10 measures assessed. Our results can help providers and payers set priorities for quality improvement efforts and value-based payments in AIS care. PRIMARY FUNDING SOURCE: National Institute of Neurological Disorders and Stroke.

Identifiers

PMID37126821
PMCPMC10211083

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.