Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study.
Benchmarking
Intensive care units
Quality indicators
Quality of health care
Traumatic brain injuries
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
04 03 2020
04 03 2020
Historique:
received:
12
11
2019
accepted:
14
02
2020
entrez:
6
3
2020
pubmed:
7
3
2020
medline:
31
10
2020
Statut:
epublish
Résumé
The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre. Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Sections du résumé
BACKGROUND
The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement.
METHODS
Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10.
RESULTS
A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre.
CONCLUSIONS
Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators.
TRIAL REGISTRATION
The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Identifiants
pubmed: 32131882
doi: 10.1186/s13054-020-2791-0
pii: 10.1186/s13054-020-2791-0
pmc: PMC7057641
doi:
Banques de données
ClinicalTrials.gov
['NCT02210221']
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
78Subventions
Organisme : Seventh Framework Programme
ID : 602150
Pays : International
Investigateurs
Cecilia Åkerlund
(C)
Krisztina Amrein
(K)
Nada Andelic
(N)
Lasse Andreassen
(L)
Gérard Audibert
(G)
Philippe Azouvi
(P)
Maria Luisa Azzolini
(ML)
Ronald Bartels
(R)
Ronny Beer
(R)
Bo-Michael Bellander
(BM)
Habib Benali
(H)
Maurizio Berardino
(M)
Luigi Beretta
(L)
Erta Beqiri
(E)
Morten Blaabjerg
(M)
Stine Borgen Lund
(SB)
Camilla Brorsson
(C)
Andras Buki
(A)
Manuel Cabeleira
(M)
Alessio Caccioppola
(A)
Emiliana Calappi
(E)
Maria Rosa Calvi
(MR)
Peter Cameron
(P)
Guillermo Carbayo Lozano
(GC)
Marco Carbonara
(M)
Ana M Castaño-León
(AM)
Simona Cavallo
(S)
Giorgio Chevallard
(G)
Arturo Chieregato
(A)
Mark Coburn
(M)
Jonathan Coles
(J)
Jamie D Cooper
(JD)
Marta Correia
(M)
Endre Czeiter
(E)
Marek Czosnyka
(M)
Claire Dahyot-Fizelier
(C)
Paul Dark
(P)
Véronique De Keyser
(V)
Vincent Degos
(V)
Francesco Della Corte
(FD)
Hugo den Boogert
(H)
Bart Depreitere
(B)
Dula Dilvesi
(D)
Abhishek Dixit
(A)
Jens Dreier
(J)
Guy-Loup Dulière
(GL)
Erzsébet Ezer
(E)
Martin Fabricius
(M)
Kelly Foks
(K)
Shirin Frisvold
(S)
Alex Furmanov
(A)
Damien Galanaud
(D)
Dashiell Gantner
(D)
Alexandre Ghuysen
(A)
Lelde Giga
(L)
Jagos Golubovic
(J)
Pedro A Gomez
(PA)
Francesca Grossi
(F)
Deepak Gupta
(D)
Iain Haitsma
(I)
Raimund Helbok
(R)
Eirik Helseth
(E)
Peter J Hutchinson
(PJ)
Stefan Jankowski
(S)
Faye Johnson
(F)
Mladen Karan
(M)
Angelos G Kolias
(AG)
Daniel Kondziella
(D)
Evgenios Koraropoulos
(E)
Lars-Owe Koskinen
(LO)
Noémi Kovács
(N)
Ana Kowark
(A)
Alfonso Lagares
(A)
Steven Laureys
(S)
Fiona Lecky
(F)
Didier Ledoux
(D)
Aurelie Lejeune
(A)
Roger Lightfoot
(R)
Alex Manara
(A)
Costanza Martino
(C)
Hugues Maréchal
(H)
Julia Mattern
(J)
Catherine McMahon
(C)
Tomas Menovsky
(T)
Benoit Misset
(B)
Visakh Muraleedharan
(V)
Lynnette Murray
(L)
Ancuta Negru
(A)
David Nelson
(D)
Virginia Newcombe
(V)
József Nyirádi
(J)
Fabrizio Ortolano
(F)
Jean-François Payen
(JF)
Vincent Perlbarg
(V)
Paolo Persona
(P)
Wilco Peul
(W)
Anna Piippo-Karjalainen
(A)
Horia Ples
(H)
Inigo Pomposo
(I)
Jussi P Posti
(JP)
Louis Puybasset
(L)
Andreea Radoi
(A)
Arminas Ragauskas
(A)
Rahul Raj
(R)
Jonathan Rhodes
(J)
Sophie Richter
(S)
Saulius Rocka
(S)
Cecilie Roe
(C)
Olav Roise
(O)
Jeffrey V Rosenfeld
(JV)
Christina Rosenlund
(C)
Guy Rosenthal
(G)
Rolf Rossaint
(R)
Sandra Rossi
(S)
Juan Sahuquillo
(J)
Oddrun Sandrød
(O)
Oliver Sakowitz
(O)
Renan Sanchez-Porras
(R)
Kari Schirmer-Mikalsen
(K)
Rico Frederik Schou
(RF)
Peter Smielewski
(P)
Abayomi Sorinola
(A)
Emmanuel Stamatakis
(E)
Nino Stocchetti
(N)
Nina Sundström
(N)
Riikka Takala
(R)
Viktória Tamás
(V)
Tomas Tamosuitis
(T)
Olli Tenovuo
(O)
Matt Thomas
(M)
Dick Tibboel
(D)
Christos Tolias
(C)
Tony Trapani
(T)
Cristina Maria Tudora
(CM)
Peter Vajkoczy
(P)
Shirley Vallance
(S)
Egils Valeinis
(E)
Zoltán Vámos
(Z)
Gregory Van der Steen
(G)
Jeroen T J M van Dijck
(JTJM)
Thomas A van Essen
(TA)
Roel P J van Wijk
(RPJ)
Alessia Vargiolu
(A)
Emmanuel Vega
(E)
Anne Vik
(A)
Rimantas Vilcinis
(R)
Victor Volovici
(V)
Daphne Voormolen
(D)
Petar Vulekovic
(P)
Guy Williams
(G)
Stefan Winzeck
(S)
Stefan Wolf
(S)
Alexander Younsi
(A)
Frederick A Zeiler
(FA)
Agate Ziverte
(A)
Tommaso Zoerle
(T)
Hans Clusmann
(H)
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