Document Detail

Patient-level and hospital-level determinants of the quality of acute stroke care: a multilevel modeling approach.
MedLine Citation:
PMID:  20966407     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Quality of care may be influenced by patient and hospital factors. Our goal was to use multilevel modeling to identify patient-level and hospital-level determinants of the quality of acute stroke care in a stroke registry.
METHODS: During 2001 to 2002, data were collected for 4897 ischemic stroke and TIA admissions at 96 hospitals from 4 prototypes of the Paul Coverdell National Acute Stroke Registry. Duration of data collection varied between prototypes (range, 2-6 months). Compliance with 8 performance measures (recombinant tissue plasminogen activator treatment, antithrombotics < 24 hours, deep venous thrombosis prophylaxis, lipid testing, dysphagia screening, discharge antithrombotics, discharge anticoagulants, smoking cessation) was summarized in a composite opportunity score defined as the proportion of all needed care given. Multilevel linear regression analyses with hospital specified as a random effect were conducted.
RESULTS: The average hospital composite score was 0.627. Hospitals accounted for a significant amount of variability (intraclass correlation = 0.18). Bed size was the only significant hospital-level variable; the mean composite score was 11% lower in small hospitals (≤ 145 beds) compared with large hospitals (≥ 500 beds). Significant patient-level variables included age, race, ambulatory status documentation, and neurologist involvement. However, these factors explained < 2.0% of the variability in care at the patient level.
CONCLUSIONS: Multilevel modeling of registry data can help identify the relative importance of hospital-level and patient-level factors. Hospital-level factors accounted for 18% of total variation in the quality of care. Although the majority of variability in care occurred at the patient level, the model was able to explain only a small proportion.
Mathew J Reeves; Julia Gargano; Kimberly S Maier; Joseph P Broderick; Michael Frankel; Kenneth A LaBresh; Charles J Moomaw; Lee Schwamm
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2010-10-21
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  41     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-30     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2924-31     Citation Subset:  IM    
Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA.
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MeSH Terms
Acute Disease
Data Collection
Health Facility Size
Hospitals / standards*
Hospitals, Teaching
Ischemic Attack, Transient / therapy
Linear Models
Models, Organizational
Multilevel Analysis
Patients / statistics & numerical data*
Quality Assurance, Health Care / methods*,  statistics & numerical data*
Quality of Health Care / statistics & numerical data*
Stroke / therapy*
Terminology as Topic

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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