Development of Quality Indicators of Stroke Centers and Feasibility of Their Measurement Using a Nationwide Insurance Claims Database in Japan ― J-ASPECT Study ―

Administrative Claims, Healthcare Aged Aged, 80 and over Comprehensive Health Care / standards Databases, Factual Delivery of Health Care, Integrated / standards Delphi Technique Feasibility Studies Female Guideline Adherence / standards Healthcare Disparities / standards Humans Japan Male Middle Aged Outcome and Process Assessment, Health Care / standards Practice Guidelines as Topic / standards Practice Patterns, Physicians' / standards Quality Improvement / standards Quality Indicators, Health Care / standards Risk Factors Stroke / diagnosis Time Factors Treatment Outcome

Cerebrovascular disease Performance measure Quality and outcomes Quality indicator Stroke

Journal

Circulation journal : official journal of the Japanese Circulation Society

ISSN: 1347-4820

Titre abrégé: Circ J

Pays: Japan

ID NLM: 101137683

Informations de publication

Date de publication:
25 10 2019

Historique:

pubmed: 27 9 2019

medline: 25 8 2020

entrez: 27 9 2019

Statut: ppublish

Résumé

We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database. 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. 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.

Sections du résumé

BACKGROUND

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.

Identifiants

DOI: 10.1253/circj.CJ-19-0089 PMID: 31554766

pubmed: 31554766

doi: 10.1253/circj.CJ-19-0089

doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Systematic Review

Langues

eng

Sous-ensembles de citation

Pagination

2292-2302

Investigateurs

Masayoshi Takigami (M)

Kenji Kamiyama (K)

Syunsuke Terasaka (S)

Tetsuyuki Yoshimoto (T)

Taiichiro Watanabe (T)

Yusuke Nakagaki (Y)

Hiroshi Ooyama (H)

Katsumi Takizawa (K)

Naoki Tokumitsu (N)

Nozomi Suzuki (N)

None Kimura

Naoto Izumi (N)

Kimito Kondo (K)

Masafumi Ohtaki (M)

Mikio Nishiya (M)

Mitsunobu Kaijima (M)

Kuniaki Ogasawara (K)

Naohiko Kubo (N)

Keiichi Saitou (K)

Atsuo Yoshino (A)

Shigeru Nogawa (S)

Hiroyuki Jimbo (H)

Hideki Murakami (H)

Ikuo Kobayashi (I)

Yoshiko Unno (Y)

Michihiro Kohno (M)

Yoshinori Arai (Y)

Akira Isoshima (A)

Mitsuhiko Hokari (M)

Taketoshi Maehara (T)

Hajime Arai (H)

Takakazu Kawamata (T)

Makoto Noguchi (M)

Haruhiko Hoshino (H)

Hirofumi Hiyama (H)

Kensaku Yoshida (K)

Mitsuyuki Fujitsuka (M)

Yasuaki Takeda (Y)

Toshio Machida (T)

Kenji Wakui (K)

Hirokazu Tanno (H)

Naoaki Sato (N)

Hideki Sakai (H)

Takayuki Watanabe (T)

Ichiro Nakahara (I)

Toshinori Hasegawa (T)

Naoto Kuwayama (N)

Noriyuki Suzaki (N)

Yukio Seki (Y)

Akira Ikeda (A)

Yotaro Takeuchi (Y)

Yoshio Araki (Y)

Hisashi Tanaka (H)

Toshio Yokoe (T)

Kenichi Murao (K)

Tomonori Yamada (T)

Toshiho Ohtsuki (T)

Akatsuki Wakayama (A)

Jun Takahashi (J)

Kouich Iwatsuki (K)

Yoshikazu Nakajima (Y)

Hidehuku Gi (H)

Ryunosuke Uranishi (R)

Yusaku Nakamura (Y)

Kazunori Yamanaka (K)

Hiroyuki Matsumoto (H)

Masashi Morikawa (M)

Masahiko Kitano (M)

Toshihiko Kuroiwa (T)

Motohiro Arai (M)

Nozomu Murai (N)

Takashi Turuno (T)

Yoshihumi Teramoto (Y)

Wataru Haraguchi (W)

Seisaburo Sakamoto (S)

Yoshiharu Tokunaga (Y)

Shigetoshi Yano (S)

Akira Takada (A)

Shu Hasegawa (S)

Toru Nishi (T)

Hiromasa Tsuiki (H)

Hiroshi Egami (H)

Tadao Kawamura (T)

Makoto Goda (M)

Yasuyuki Nagai (Y)

Shiro Miyata (S)

Hideo Takeshima (H)

Hajime Ohta (H)

Kazuho Hirahara (K)

Teruaki Kawano (T)

Souichi Obara (S)

Sei Sugata (S)

Shogo Ishiuchi (S)

Susumu Mekaru (S)

Tomoaki Nagamine (T)

Koji Idomari (K)

Tsutomu Kadekaru (T)

Ken-Ichi Morita (KI)

Yukihiko Fujii (Y)

Kiyoshi Onda (K)

Shigekazu Takeuchi (S)

Hiroshi Abe (H)

Mitsuo Kouno (M)

Michitoku Igarashi (M)

Yukio Horie (Y)

Hiroaki Hondo (H)

Ryouichi Masuda (R)

Naoki Shirasaki (N)

Hisashi Nitta (H)

Mitsutoshi Nakada (M)

Syuji Sato (S)

Hiroki Toda (H)

Osamu Yamamura (O)

Masanori Kabuto (M)

Hiroyuki Kinouchi (H)

Shin Nakano (S)

Mikito Uchida (M)

Syougo Imae (S)

Hiroshi Ozawa (H)

Osamu Nishizaki (O)

Masakazu Suga (M)

Shinji Iwata (S)

Kiichiro Zenke (K)

Masato Seike (M)

Satoru Hayashi (S)

Tsuyoshi Oota (T)

Tetsuya Ueba (T)

Hiroyuki Nishimura (H)

Norihito Shirakawa (N)

Masahiro Kagawa (M)

Naoki Hayashi (N)

Takashi Tamiya (T)

Kimihiro Yoshino (K)

Tetsuya Masaoka (T)

Taketo Hatano (T)

Shinya Yamaguchi (S)

Yuuji Okamoto (Y)

Shigenari Kin (S)

Haruki Takahashi (H)

Satoshi Suzuki (S)

Koji Iihara (K)

Katsuyuki Hirakawa (K)

Akira Nakamizo (A)

Koichirou Matsukado (K)

Masaharu Tani (M)

Yoshihisa Maeda (Y)

Tsutomu Hitotsumatsu (T)

Terukazu Kuramoto (T)

Yoshihisa Matumoto (Y)

Tooru Inoue (T)

Motohiro Morioka (M)

Masahiro Mizoguchi (M)

Shuji Sakata (S)

Nobuaki Momozaki (N)

Masayuki Miyazono (M)

Akihiro Nemoto (A)

Yasunori Takemoto (Y)

Takaakira Yokoyama (T)

Takayuki Tachizawa (T)

Katsumi Sakata (K)

Hidetoshi Murata (H)

Hitoshi Ozawa (H)

Makoto Inaba (M)

Takahisa Mori (T)

Yasuhiro Hasegawa (Y)

Keiichirou Onitsuka (K)

Sumio Endo (S)

Atsuhiro Kojima (A)

Akira Tsunoda (A)

Kyoichi Nomura (K)

Toshiki Ikeda (T)

Masahiko Tanaka (M)

Hiroshi Wanihuchi (H)

Hirochiyo Wada (H)

Akio Hyodo (A)

Ken Asakura (K)

Kazunori Akazi (K)

Shigehiro Ohmori (S)

Satoshi Magarisawa (S)

Shinichi Okabe (S)

Shinji Yamamoto (S)

Hiroko Oyama (H)

Yuji Matsumaru (Y)

Kazuya Uemura (K)

Hitoshi Tabata (H)

Keishi Fujita (K)

Masayuki Ishihara (M)

Kazuhiro Kikuchi (K)

Nobukuni Murakami (N)

Minoru Kidooka (M)

Yosihiro Iwamoto (Y)

Kouji Shiga (K)

Yuko Shikata (Y)

Eiji Kohmura (E)

Takeshi Kondoh (T)

Haruo Yamashita (H)

Keigo Matsumoto (K)

Naoya Takeda (N)

Hiroji Miyake (H)

Eiichirou Mabuchi (E)

Hideyuki Ohnishi (H)

Yuji Tsukazaki (Y)

Osamu Narumi (O)

Minoru Asahi (M)

Kazuhiro Tanaka (K)

Yoshio Sakagami (Y)

Shinya Noda (S)

Tetsuya Morimoto (T)

Hiroyuki Nakase (H)

Toshikazu Kuwata (T)

Yoshinari Nakamura (Y)

Mitsukazu Nakai (M)

Teruyuki Habu (T)

Masamichi Kurosaki (M)

Hiroki Ohkuma (H)

Seiko Hasegawa (S)

Hiromu Konno (H)

Atsuhito Takemura (A)

Junta Moroi (J)

Hiroaki Shimizu (H)

Yoichi Watanabe (Y)

Taku Sato (T)

Satoshi Taira (S)

Zenichiro Watanabe (Z)

Takayuki Koizumi (T)

Yasuhiro Suzuki (Y)

Yukihiko Sonoda (Y)

Eiichiro Kamatsuka (E)

Keiten So (K)

Tooru Sasaki (T)

Yohei Kudou (Y)

Hirosi Maruya (H)

Hiroaki Arai (H)

Hidenori Endo (H)

Hiroshi Karibe (H)

Masayuki Nakajima (M)

Kazuyoshi Watanabe (K)

Kazuhiko Nozaki (K)

Motohiro Takayama (M)

Taro Komuro (T)

Hisao Hirai (H)

Hidenori Suzuki (H)

Hiroto Murata (H)

Fumitaka Miya (F)

Seiji Fukazawa (S)

Teiji Nakayama (T)

Haruhiko Sato (H)

Tetsuya Tanigawara (T)

Toru Iwama (T)

Junki Ito (J)

Shinji Noda (S)

Kazuo Kitazawa (K)

Yoshikazu Kusano (Y)

Masanobu Hokama (M)

Shinsuke Muraoka (S)

Keiichi Sakai (K)

Tatsuya Mizoue (T)

Takato Kagawa (T)

Hiroyuki Nakashima (H)

Koji Tokunaga (K)

Isao Date (I)

Chin Masaki (C)

Hidemichi Sasayama (H)

Akira Watanabe (A)

Manabu Urakawa (M)

Yasuhiro Hamada (Y)

Michiyasu Suzuki (M)

Takafumi Nishizaki (T)

Katsuhiro Yamashita (K)

Takaharu Nakamura (T)

Masayuki Sumida (M)

Shinichi Wakabayashi (S)

Takahito Okazaki (T)

Yukihiko Kawamoto (Y)

Kenjirou Hujiwara (K)

Takashi Matsuoka (T)

Osamu Hamasaki (O)

Shinji Nagahiro (S)

Masahito Agawa (M)

Kunikazu Yoshimura (K)

Sei Haga (S)

Katsuyuki Asaoka (K)

Toshitaka Nakamura (T)

Makoto Takeda (M)

Satoshi Ushikoshi (S)

Nobuhiro Mikuni (N)

Jun Niwa (J)

Rokuya Tanikawa (R)

Akira Takahashi (A)

Yasunari Otawara (Y)

Kazuyuki Miura (K)

Teiji Tominaga (T)

Masayuki Ezura (M)

Toshie Takahashi (T)

Masahiro Yoshida (M)

Sunao Takemura (S)

Masahisa Kawakami (M)

Yasushi Shibata (Y)

Takashi Saegusa (T)

Toshihiko Iuchi (T)

Seiichiro Hoshi (S)

Sadao Suga (S)

Tomonori Kobayashi (T)

Naohisa Miura (N)

Yoshiaki Takada (Y)

Takahiro Oota (T)

Takashi Kumagai (T)

Keiichi Nishimaki (K)

Kazuhiro Hongo (K)

Takayuki Kuroyanagi (T)

Atsushi Sato (A)

Satoshi Kuroda (S)

Cheho Park (C)

Hirohumi Oyama (H)

Noriaki Matubara (N)

Mitsuhito Mase (M)

Toshikazu Ichihashi (T)

Katsunobu Takenaka (K)

Takayuki Kato (T)

Yoshinari Okumura (Y)

Takatoshi Fujimoto (T)

Susumu Miyamoto (S)

Yoshinori Akiyama (Y)

Kenji Hashimoto (K)

Masaaki Saiki (M)

Kazuo Yamamoto (K)

Naofumi Isono (N)

Misao Nishikawa (M)

Shinichi Yoshimura (S)

Hideo Aihara (H)

Hajimu Miyake (H)

Kazuyuki Kuwayama (K)

Kotaro Ogihara (K)

Shigeki Nishino (S)

Keiichi Akatsuka (K)

Junkoh Yamamoto (J)

Yoshimasa Kinosita (Y)

Satoshi Inoha (S)

Hitonori Takaba (H)

Tadahisa Shono (T)

Hitoshi Tsugu (H)

Shuji Hayashi (S)

Tatsuya Abe (T)

Taketoshi Tuji (T)

Keizou Yamamoto (K)

Akihiko Kaga (A)

Kouji Takasaki (K)

Shigeru Oya (S)

Nobuyuki Sakai (N)

Yasuhisa Yoshida (Y)

Yasunari Niimi (Y)

Isao Kitahara (I)

Hidemitu Nakagawa (H)

Kiyoshi Kazekawa (K)

Kouzou Fukuyama (K)

Makoto Ichinose (M)

Koji Matuoka (K)

Yasuhiro Fujimoto (Y)

Youichi Hashimoto (Y)

Takeshi Matsuoka (T)

Takamitsu Uchizawa (T)

Makoto Hasebe (M)

Tomoaki Kameda (T)

Takayuki Kubodera (T)

Satoshi Utsuki (S)

Kazuaki Awamori (K)

Kazumasa Yamatani (K)

Toshiyuki Tsukada (T)

Masakazu Kitahara (M)

Yukinari Kakizawa (Y)

Yasumasa Yamamoto (Y)

Takashi Yoshida (T)

Shinji Okumura (S)

Yasunobu Goto (Y)

Takashi Tominaga (T)

Hirotoshi Hamaguchi (H)

Naoki Shinohara (N)

Masaru Idei (M)

Yoshihiro Nishiura (Y)

Hiromichi Koga (H)

Jae-Hyun Son (JH)

Yoshimasa Niiya (Y)

Tsuneo Shishido (T)

Mamoru Murakami (M)

Takaaki Yoshida (T)

Tatsuya Nakamura (T)

Takuya Kawai (T)

Isao Sasaki (I)

Katsuhiko Hayashi (K)

Naoko Fujimura (N)

Seiko Kataoka (S)

Masayuki Yokota (M)