Abstract
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).
Original language | English |
---|---|
Article number | 78 |
Journal | Critical care (London, England) |
Volume | 24 |
Issue number | 1 |
DOIs | |
Publication status | Published - 4 Mar 2020 |
Keywords
- Benchmarking
- Intensive care units
- Quality indicators
- Quality of health care
- Traumatic brain injuries
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In: Critical care (London, England), Vol. 24, No. 1, 78, 04.03.2020.
Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - Quality indicators for patients with traumatic brain injury in European intensive care units: A CENTER-TBI study
AU - Huijben, Jilske A.
AU - Wiegers, Eveline J. A.
AU - Ercole, Ari
AU - de Keizer, Nicolette F.
AU - Maas, Andrew I. R.
AU - Steyerberg, Ewout W.
AU - Citerio, Giuseppe
AU - Wilson, Lindsay
AU - Polinder, Suzanne
AU - Nieboer, Daan
AU - Menon, David
AU - Lingsma, Hester F.
AU - van der Jagt, Mathieu
AU - Åkerlund, Cecilia
AU - Amrein, Krisztina
AU - Andelic, Nada
AU - Andreassen, Lasse
AU - Audibert, G. rard
AU - Azouvi, Philippe
AU - Azzolini, Maria Luisa
AU - Bartels, Ronald
AU - Beer, Ronny
AU - Bellander, Bo-Michael
AU - Benali, Habib
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Beqiri, Erta
AU - Blaabjerg, Morten
AU - Lund, Stine Borgen
AU - Brorsson, Camilla
AU - Buki, Andras
AU - Cabeleira, Manuel
AU - Caccioppola, Alessio
AU - Calappi, Emiliana
AU - Calvi, Maria Rosa
AU - Cameron, Peter
AU - Lozano, Guillermo Carbayo
AU - Carbonara, Marco
AU - Castaño-León, Ana M.
AU - Cavallo, Simona
AU - Chevallard, Giorgio
AU - Chieregato, Arturo
AU - Coburn, Mark
AU - Coles, Jonathan
AU - Cooper, Jamie D.
AU - Correia, Marta
AU - Czeiter, Endre
AU - Czosnyka, Marek
AU - Dahyot-Fizelier, Claire
AU - Dark, Paul
AU - de Keyser, V. ronique
AU - Degos, Vincent
AU - Corte, Francesco Della
AU - den Boogert, Hugo
AU - Depreitere, Bart
AU - Dilvesi, Dula
AU - Dixit, Abhishek
AU - Dreier, Jens
AU - Dulière, Guy-Loup
AU - Ezer, Erzsébet
AU - Fabricius, Martin
AU - Foks, Kelly
AU - Frisvold, Shirin
AU - Furmanov, Alex
AU - Galanaud, Damien
AU - Gantner, Dashiell
AU - Ghuysen, Alexandre
AU - Giga, Lelde
AU - Golubovic, Jagos
AU - Gomez, Pedro A.
AU - Grossi, Francesca
AU - Gupta, Deepak
AU - Haitsma, Iain
AU - Helbok, Raimund
AU - Helseth, Eirik
AU - Hutchinson, Peter J.
AU - Jankowski, Stefan
AU - Johnson, Faye
AU - Karan, Mladen
AU - Kolias, Angelos G.
AU - Kondziella, Daniel
AU - Koraropoulos, Evgenios
AU - Koskinen, Lars-Owe
AU - Kovács, Noémi
AU - Kowark, Ana
AU - Lagares, Alfonso
AU - Laureys, Steven
AU - Lecky, Fiona
AU - Ledoux, Didier
AU - Lejeune, Aurelie
AU - Lightfoot, Roger
AU - Manara, Alex
AU - Martino, Costanza
AU - Maréchal, Hugues
AU - Mattern, Julia
AU - McMahon, Catherine
AU - Menovsky, Tomas
AU - Misset, Benoit
AU - Muraleedharan, Visakh
AU - Murray, Lynnette
AU - Negru, Ancuta
AU - Nelson, David
AU - Newcombe, Virginia
AU - Nyirádi, J. zsef
AU - Ortolano, Fabrizio
AU - Payen, Jean-François
AU - Perlbarg, Vincent
AU - Persona, Paolo
AU - Peul, Wilco
AU - Piippo-Karjalainen, Anna
AU - Ples, Horia
AU - Pomposo, Inigo
AU - Posti, Jussi P.
AU - Puybasset, Louis
AU - Radoi, Andreea
AU - Ragauskas, Arminas
AU - Raj, Rahul
AU - Rhodes, Jonathan
AU - Richter, Sophie
AU - Rocka, Saulius
AU - Roe, Cecilie
AU - Roise, Olav
AU - Rosenfeld, Jeffrey V.
AU - Rosenlund, Christina
AU - Rosenthal, Guy
AU - Rossaint, Rolf
AU - Rossi, Sandra
AU - Sahuquillo, Juan
AU - Sandrød, Oddrun
AU - Sakowitz, Oliver
AU - Sanchez-Porras, Renan
AU - Schirmer-Mikalsen, Kari
AU - Schou, Rico Frederik
AU - Smielewski, Peter
AU - Sorinola, Abayomi
AU - Stamatakis, Emmanuel
AU - Stocchetti, Nino
AU - Sundström, Nina
AU - Takala, Riikka
AU - Tamás, Viktória
AU - Tamosuitis, Tomas
AU - Tenovuo, Olli
AU - Thomas, Matt
AU - Tibboel, Dick
AU - Tolias, Christos
AU - Trapani, Tony
AU - Tudora, Cristina Maria
AU - Vajkoczy, Peter
AU - Vallance, Shirley
AU - Valeinis, Egils
AU - Vámos, Zoltán
AU - van der Steen, Gregory
AU - van Dijck, Jeroen T. J. M.
AU - van Essen, Thomas A.
AU - van Wijk, Roel P. J.
AU - Vargiolu, Alessia
AU - Vega, Emmanuel
AU - Vik, Anne
AU - Vilcinis, Rimantas
AU - Volovici, Victor
AU - Voormolen, Daphne
AU - Vulekovic, Petar
AU - Williams, Guy
AU - Winzeck, Stefan
AU - Wolf, Stefan
AU - Younsi, Alexander
AU - Zeiler, Frederick A.
AU - Ziverte, Agate
AU - Zoerle, Tommaso
AU - Clusmann, Hans
N1 - Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/3/4
Y1 - 2020/3/4
N2 - 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).
AB - 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).
KW - Benchmarking
KW - Intensive care units
KW - Quality indicators
KW - Quality of health care
KW - Traumatic brain injuries
UR - http://www.scopus.com/inward/record.url?scp=85081276233&partnerID=8YFLogxK
U2 - https://doi.org/10.1186/s13054-020-2791-0
DO - https://doi.org/10.1186/s13054-020-2791-0
M3 - Article
C2 - 32131882
SN - 1364-8535
VL - 24
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 1
M1 - 78
ER -