Estimating and reporting on the quality of inpatient stroke care by veterans health administration medical centers

Gregory Arling, Mathew Reeves, Joseph Ross, Linda Williams, Salomeh Keyhani, Neale Chumbler, Michael S. Phipps, Christianne Roumie, Laura J. Myers, Amanda H. Salanitro, Diana L. Ordin, Jennifer Myers, Dawn Bravata

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background-Reporting of quality indicators (QIs) in Veterans Health Administration Medical Centers is complicated by estimation error caused by small numbers of eligible patients per facility. We applied multilevel modeling and empirical Bayes (EB) estimation in addressing this issue in performance reporting of stroke care quality in the Medical Centers. Methods and Results-We studied a retrospective cohort of 3812 veterans admitted to 106 Medical Centers with ischemic stroke during fiscal year 2007. The median number of study patients per facility was 34 (range, 12-105). Inpatient stroke care quality was measured with 13 evidence-based QIs. Eligible patients could either pass or fail each indicator. Multilevel modeling of a patient's pass/fail on individual QIs was used to produce facility-level EB-estimated QI pass rates and confidence intervals. The EB estimation reduced interfacility variation in QI rates. Small facilities and those with exceptionally high or low rates were most affected. We recommended 8 of the 13 QIs for performance reporting: Dysphagia screening, National Institutes of Health Stroke Scale documentation, early ambulation, fall risk assessment, pressure ulcer risk assessment, Functional Independence Measure documentation, lipid management, and deep vein thrombosis prophylaxis. These QIs displayed sufficient variation across facilities, had room for improvement, and identified sites with performance that was significantly above or below the population average. The remaining 5 QIs were not recommended because of too few eligible patients or high pass rates with little variation. Conclusions-Considerations of statistical uncertainty should inform the choice of QIs and their application to performance reporting.

Original languageEnglish
Pages (from-to)44-51
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume5
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Veterans Health
United States Department of Veterans Affairs
Inpatients
Stroke
Quality of Health Care
Documentation
Early Ambulation
Pressure Ulcer
National Institutes of Health (U.S.)
Veterans
Deglutition Disorders
Venous Thrombosis
Uncertainty
Confidence Intervals
Lipids
Population

Keywords

  • Acute stroke
  • Performance measurement
  • Quality indicators
  • Statistics
  • Stroke management

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Estimating and reporting on the quality of inpatient stroke care by veterans health administration medical centers. / Arling, Gregory; Reeves, Mathew; Ross, Joseph; Williams, Linda; Keyhani, Salomeh; Chumbler, Neale; Phipps, Michael S.; Roumie, Christianne; Myers, Laura J.; Salanitro, Amanda H.; Ordin, Diana L.; Myers, Jennifer; Bravata, Dawn.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 5, No. 1, 01.2012, p. 44-51.

Research output: Contribution to journalArticle

Arling, Gregory ; Reeves, Mathew ; Ross, Joseph ; Williams, Linda ; Keyhani, Salomeh ; Chumbler, Neale ; Phipps, Michael S. ; Roumie, Christianne ; Myers, Laura J. ; Salanitro, Amanda H. ; Ordin, Diana L. ; Myers, Jennifer ; Bravata, Dawn. / Estimating and reporting on the quality of inpatient stroke care by veterans health administration medical centers. In: Circulation: Cardiovascular Quality and Outcomes. 2012 ; Vol. 5, No. 1. pp. 44-51.
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