Zeenat Qureshi Stroke Research Center, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
Neurocrit Care. 2011 Apr;14(2):291-317. doi: 10.1007/s12028-010-9453-z.
Intracerebral hemorrhage (ICH) care can vary among centers and previous studies have demonstrated differences in ICH outcome based on variations in patient care in various settings. The purpose of this paper is to present the design of an evidence-based dataset of elements of a new ICH specific intensity of care quality metrics.
The articles were identified based on personal knowledge of the subject supplemented by data derived from multi-center randomized trials, and selected non-randomized or observational clinical studies. The information was identified with multiple searches on MEDLINE from 1986 through 2009. The current guidelines from American Heart Association (AHA)/American Stroke Association (ASA) Stroke Council and The European Stroke Initiative (EUSI) Writing Committee for management of ICH were reviewed extensively for identifying quality indicators and available scientific evidence. For certain elements where stroke-specific data was not available, data derived from other disease process with direct relevance was used.
A total of 26 quality indicators related to 18 facets of care with thresholds for quality response were identified. A pilot study was performed to asses and score 1300 (26 indicator per patientX25 patientsX2 raters) quality indicators. The minimum proportion of patients meeting quality parameter ranged from 44% to 100% depending upon the variable. The lowest performance scores were observed in the early intubation and mechanical ventilation, treatment of significant intracranial mass effect or transtentorial herniation, and timely acquisition of neuroimaging. The highest performance scores were seen in treatment of any seizure within 2 weeks of admission, status epilepticus, and prevention of gastric ulcer.
The next step in development of a new ICH specific intensity of care quality metrics is validation and refinement of the quality indicators and thresholds presented in the current report. Future activities may include selection and validation based on consensus of experts and application of the system to a large series of patients with ICH and assessment of relationship of components in isolation and as a group to outcome after severity adjustment.
脑出血（ICH）的治疗在各中心之间可能存在差异，既往研究已经证明，在不同环境下，患者治疗的差异会导致 ICH 预后的不同。本文旨在介绍一种新的ICH 特定强度护理质量指标的设计，该设计基于循证数据集的元素。
本文基于对该主题的个人了解，并辅以多中心随机试验和选定的非随机或观察性临床研究的数据，对文章进行了识别。通过对 MEDLINE 进行多次搜索，从 1986 年到 2009 年，获取了相关信息。美国心脏协会（AHA）/美国卒中协会（ASA）卒中委员会和欧洲卒中倡议（EUSI）ICH 管理写作委员会的现行指南被广泛审查，以确定质量指标和现有的科学证据。对于某些没有特定于卒中数据的指标，使用与其他具有直接相关性的疾病过程的数据。
确定了 26 个与护理 18 个方面相关的质量指标，以及质量反应的阈值。进行了一项试点研究，以评估和评分 1300 个（每个患者 26 个指标×25 个患者×2 个评估者）质量指标。符合质量参数的患者比例最低为 44%至 100%，具体取决于变量。在早期插管和机械通气、治疗显著颅内压增高或穿颅疝、以及及时获取神经影像学方面，表现最差。在治疗入院后 2 周内的任何癫痫发作、癫痫持续状态和预防胃溃疡方面，表现最好。
开发新的 ICH 特定强度护理质量指标的下一步是验证和完善本报告中提出的质量指标和阈值。未来的活动可能包括基于专家共识的选择和验证，以及将该系统应用于大量 ICH 患者，并评估孤立和作为一个整体的各个组成部分与严重程度调整后结果之间的关系。
