Development of Quality Indicators of Stroke Centers and Feasibility of Their Measurement Using a Nationwide Insurance Claims Database in Japan ― J-ASPECT Study ―.
Обработка статьи · этапы, ошибки и управление
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Nishimura Ataru, Nishimura Kunihiro, Onozuka Daisuke, Matsuo Ryu, Kada Akiko, Kamitani Satoru, Higashi Takahiro, Ogasawara Kuniaki, Shimodozono Megumi, Harada Masafumi, Hashimoto Yoichiro, Hirano Teruyuki, Hoshino Haruhiko, Itabashi Ryo, Itoh Yoshiaki, Iwama Toru, Kohriyama Tatsuo, Matsumaru Yuji, Osato Toshiaki, Sasaki Makoto, Shiokawa Yoshiaki, Shimizu Hiroaki, Takekawa Hidehiro, Nishi Toru, Uno Masaaki, Yagita Yoshiki, Ido Keisuke, Kurogi Ai, Kurogi Ryota, Arimura Koichi, Ren Nice, Hagihara Akihito, Takizawa Shunya, Arai Hajime, Kitazono Takanari, Miyamoto Susumu, Minematsu Kazuo, Iihara Koji, J-ASPECT study collaborators
Аннотация
METHODS AND RESULTS: We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013-2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6% and 58.7%; discharge anticoagulation for atrial fibrillation, 64.4%; discharge antihypertensive agents, 51.7%; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9%; death complications of diagnostic neuroangiography, 0.4%). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics.
CONCLUSIONS: We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.