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Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.

Publication ,  Journal Article
Xian, Y; Holloway, RG; Pan, W; Peterson, ED
Published in: Stroke
June 2012

BACKGROUND AND PURPOSE: Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate. METHODS: Using the 2005 to 2006 New York state data, we examined the degree to which hospital stroke mortality rankings varied regarding ischemic versus hemorrhagic versus total stroke. Observed/expected ratio was calculated using the Agency for Healthcare Research and Quality Inpatient Quality Indicator software. The observed/expected ratio and outlier status based on stroke types across hospitals were examined using Pearson correlation coefficients (r) and weighted κ. RESULTS: Overall 30-day stroke mortality rates were 15.2% and varied from 11.3% for ischemic stroke and 37.3% for intracerebral hemorrhage. Hospital risk-adjusted ischemic stroke observed/expected ratio was weakly correlated with its own intracerebral hemorrhage observed/expected ratio (r=0.38). When examining hospital performance group (mortality better, worse, or no different than average), disagreement was observed in 35 of 81 hospitals (κ=0.23). Total stroke mortality observed/expected ratio and rankings were correlated with intracerebral hemorrhage (r=0.61 and κ=0.36) and ischemic stroke (r=0.94 and κ=0.71), but many hospitals still switched classification depending on mortality metrics. However, hospitals treating a higher percent of hemorrhagic stroke did not have a statistically significant higher total stroke mortality rate relative to those treating fewer hemorrhagic strokes. CONCLUSIONS: Hospital stroke mortality ratings varied considerably depending on whether ischemic, hemorrhagic, or total stroke mortality rates were used. Public reporting of stroke mortality measures should consider providing risk-adjusted outcome on separate stroke types.

Duke Scholars

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Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

June 2012

Volume

43

Issue

6

Start / End Page

1687 / 1690

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • New York
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospital Mortality
  • Female
  • Cerebral Hemorrhage
  • Brain Ischemia
 

Citation

APA
Chicago
ICMJE
MLA
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Xian, Y., Holloway, R. G., Pan, W., & Peterson, E. D. (2012). Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates. Stroke, 43(6), 1687–1690. https://doi.org/10.1161/STROKEAHA.111.648600
Xian, Ying, Robert G. Holloway, Wenqin Pan, and Eric D. Peterson. “Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.Stroke 43, no. 6 (June 2012): 1687–90. https://doi.org/10.1161/STROKEAHA.111.648600.
Xian, Ying, et al. “Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.Stroke, vol. 43, no. 6, June 2012, pp. 1687–90. Pubmed, doi:10.1161/STROKEAHA.111.648600.

Published In

Stroke

DOI

EISSN

1524-4628

Publication Date

June 2012

Volume

43

Issue

6

Start / End Page

1687 / 1690

Location

United States

Related Subject Headings

  • Time Factors
  • Stroke
  • New York
  • Neurology & Neurosurgery
  • Male
  • Humans
  • Hospital Mortality
  • Female
  • Cerebral Hemorrhage
  • Brain Ischemia