国家神经系统疾病临床医学研究中心数据管理与共享系统
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Sources of hospital-level variation in functional outcome after acute ischemic stroke: a multicenter retrospective cohort study
第一作者：Runhua Zhang
通讯作者：Maigeng Zhou
基本信息
- 负责人：Runhua Zhang
- 数据来源： CNSR-Ⅲ
- 论文编号：CNSR-Ⅲ20200248
- 发表时间：2021-09-17
2021-09-17
已发表文章
发表杂志： Annals of Palliative Medicine
发表类型: Original Contributions
影响因子(IF): 2.595
PMID: 34551572 Pubmed原文链接 全文下载
主要研究背景及目的
Mortality is a key performance indicator for the quality of care. Given the variations in patient risk profiles and regional patterns of care, there can be an expected variation in mortality after stroke among hospitals. The variation in mortality may result from the case-mix, process of care, or chance. It is not well understood the extent to which these factors influence the variation in mortality after acute ischemic stroke. The study was aimed to characterize the hospital variation in 1-year mortality after ischemic stroke and investigate the extent to which case mix and in-hospital process of care contributed to the hospital variation of mortality after acute ischemic stroke.
方法
Methods: We retrospectively analyzed patients enrolled in the Third China National Stroke Registry from 2015 to 2018. The outcome was poor functional outcome (modified Rankin Scale score of 3–6) at 3 months and 1 year. We used the median odds ratio to quantify the hospital-level variation in rates of poor functional outcome. A series of hierarchical logistic models were constructed to assess the extent to which patient characteristics, hospital characteristics, process of care, and medication persistence contributed to the hospital variation.
结论
There was a wide variation in rates of functional outcomes across hospitals. Approximately half of the variation at 1 year can be explained by patient characteristics, hospital characteristics, process of care, and medication persistence. Approximately 11.5% of the variation can be modified through improvements in the process of care and medication persistence. More studies are needed to explore the contribution of post-discharge care in the future.
主要结果
A total of 13,218 patients with acute ischemic stroke from 159 hospitals were included. The riskadjusted rates of the poor functional outcome at 3 months and 1 year after ischemic stroke varied across hospitals, ranging from 6.0% to 26.0% and 6.8% to 24.0%, respectively. The median odds ratio was 1.78 at 3 months and 1.67 at 1 year. Hierarchical logistic models indicated that the patient characteristics, hospital characteristics, process of care, and the medication persistence explained 27.5%, 7.0%, 6.5%, and 5.0% of the variation at 1 year. Altogether, 36.8% and 46.1% of the hospital variation in 3-month and 1-year poor functional outcome, respectively, was explained.