| アブストラクト | BACKGROUND: 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. 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. |
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| ジャーナル名 | Circulation journal : official journal of the Japanese Circulation Society |
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| 投稿日 | 2019/9/27 |
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| 投稿者 | Nishimura, Ataru; Nishimura, Kunihiro; Onozuka, Daisuke; Matsuo, Ryu; Kada, Akiko; Kamitani, Satoru; Higashi, Takahiro; Ogasawara, Kuniaki; Shimodozono, Megumi; Harada, Masafumi; Hashimoto, Yoichiro; Hirano, Teruyuki; Hoshino, Haruhiko; Itabashi, Ryo; Itoh, Yoshiaki; Iwama, Toru; Kohriyama, Tatsuo; Matsumaru, Yuji; Osato, Toshiaki; Sasaki, Makoto; Shiokawa, Yoshiaki; Shimizu, Hiroaki; Takekawa, Hidehiro; Nishi, Toru; Uno, Masaaki; Yagita, Yoshiki; Ido, Keisuke; Kurogi, Ai; Kurogi, Ryota; Arimura, Koichi; Ren, Nice; Hagihara, Akihito; Takizawa, Shunya; Arai, Hajime; Kitazono, Takanari; Miyamoto, Susumu; Minematsu, Kazuo; Iihara, Koji |
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| 組織名 | Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu;University.;Statistics and Data Analysis, National Cerebral and Cardiovascular Center.;Department of Health Communication, Kyushu University Graduate School of Medical;Sciences.;Department of Health Care Administration and Management, Graduate School of;Medical Sciences, Kyushu University.;Department of Clinical Research Management, National Hospital Organization Nagoya;Medical Center.;Division of Health Services Research, Center for Cancer Control and Information;Services, National Cancer Center.;Department of Neurosurgery, Iwate Medical University.;Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate;School of Medical and Dental Sciences.;Department of Radiology, Tokushima University Graduate School of Medical;Department of Neurology, Kumamoto City Hospital.;Department of Stroke and Cerebrovascular Medicine, Kyorin University School of;Medicine.;Department of Neurology, Tokyo Saiseikai Central Hospital.;Department of Stroke Neurology, Kohnan Hospital.;Department of Neurology, Graduate School of Medicine, Osaka City University.;Department of Neurosurgery, Gifu University Graduate School of Medicine.;Brain Attack Center Ota Memorial Hospital.;Department of Neurosurgery, Faculty of Medicine, University of Tsukuba.;Department of Neurosurgery, Nakamura Memorial Hospital.;Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical;Department of Neurosurgery, Kyorin University School of Medicine.;Department of Neurosurgery, Akita University Graduate School of Medicine.;Department of Neurology, Dokkyo Medical University.;Division of Neurosurgery, Saiseikai Kumamoto Hospital.;Department of Neurosurgery, Kawasaki Medical School.;Department of Stroke Medicine, Kawasaki Medical School.;Department of Neurology, Department of Internal Medicine, Tokai University School;of Medicine.;Department of Neurosurgery, Juntendo University School of Medicine.;Department of Medicine and Clinical Science, Graduate School of Medical Sciences,;Kyushu University.;Department of Neurosurgery, Kyoto University Graduate School of Medicine.;National Cerebral and Cardiovascular Center. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/31554766/ |
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