Salinas Joel, Sprinkhuizen Sara M, Ackerson Teri, Bernhardt Julie, Davie Charlie, George Mary G, Gething Stephanie, Kelly Adam G, Lindsay Patrice, Liu Liping, Martins Sheila C O, Morgan Louise, Norrving Bo, Ribbers Gerard M, Silver Frank L, Smith Eric E, Williams Linda S, Schwamm Lee H
From the International Consortium of Health Outcomes Measurement, Cambridge, MA (J.S., S.M.S.); Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.S., L.H.S.); American Heart Association/American Stroke Association (AHA/ASA), Liberty Hospital, MO (T.A.); The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia (J.B.); UCLPartners Academic Health Science Network, Royal Free London NHS Foundation Trust, London, United Kingdom (C.D.); Division for Heart Disease and Stroke Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA (M.G.G.); Aneurin Bevan University Health Board, Wales, United Kingdom (S.G.); University of Rochester Medical Center, NY (A.G.K.); Heart and Stroke Foundation of Canada, World Stroke Organization, Ottawa, Ontario, Canada (P.L.); Capital Medical University, Beijing Tiantan Hospital, Beijing, China (L.L.); Hospital Moinhos de Vento, National Stroke Registry, Brazilian Stroke Society, Porto Alegre, Brazil (S.C.O.M.); AHA/ASA, Dallas, TX (L.M.); Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden (B.N.); Swedish Stroke Register (Riksstroke), Umeå, Sweden (B.N.); Erasmus University MC, Rijndam Rehabilitation Center, Rotterdam, The Netherlands (G.M.R.); Ontario Stroke Registry, University of Toronto, Toronto, Ontario, Canada (F.L.S.); Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Canada (E.E.S.); VA HSR&D Stroke QUERI, Indiana University School of Medicine, Indianapolis (L.S.W.); AHA/ASA Get With The Guidelines-Stroke Registry (L.H.S.); Paul Coverdell National Acute Stroke Registry (L.H.S.); Stroke Joint Commission (L.H.S.); and Primary and Comprehensive Stroke Center Certification Programs (L.H.S.).
Stroke. 2016 Jan;47(1):180-6. doi: 10.1161/STROKEAHA.115.010898. Epub 2015 Nov 24.
Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures was defined for use in a variety of healthcare settings.
A modified Delphi process was implemented with an international expert panel representing patients, advocates, and clinical specialists in stroke outcomes, stroke registers, global health, epidemiology, and rehabilitation to reach consensus on the preferred outcome measures, included populations, and baseline risk adjustment variables.
Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage were selected as the target population for these recommendations, with the inclusion of transient ischemic attacks optional. Outcome categories recommended for assessment were survival and disease control, acute complications, and patient-reported outcomes. Patient-reported outcomes proposed for assessment at 90 days were pain, mood, feeding, selfcare, mobility, communication, cognitive functioning, social participation, ability to return to usual activities, and health-related quality of life, with mobility, feeding, selfcare, and communication also collected at discharge. One instrument was able to collect most patient-reported subdomains (9/16, 56%). Minimum data collection for risk adjustment included patient demographics, premorbid functioning, stroke type and severity, vascular and systemic risk factors, and specific treatment/care-related factors.
A consensus stroke measure Standard Set was developed as a simple, pragmatic method to increase the value of stroke care. The set should be validated in practice when used for monitoring and comparisons across different care settings.
基于价值的医疗保健旨在使患者和医疗系统共同努力，以最大化质量与成本的比率。为了能够评估卒中管理中的医疗保健价值，定义了一套以患者为中心的国际标准卒中结局指标，用于各种医疗环境。
采用改良的德尔菲法，与一个国际专家小组进行合作，该小组代表患者、倡导者以及卒中结局、卒中登记、全球健康、流行病学和康复领域的临床专家，就首选结局指标、纳入人群和基线风险调整变量达成共识。
因缺血性卒中或脑出血就诊于医院的患者被选为这些建议的目标人群，短暂性脑缺血发作的纳入为可选。建议用于评估的结局类别包括生存与疾病控制、急性并发症以及患者报告的结局。建议在90天时评估的患者报告结局包括疼痛、情绪、进食、自我护理、活动能力、沟通、认知功能、社会参与、恢复日常活动的能力以及健康相关生活质量，出院时还收集活动能力、进食、自我护理和沟通方面的情况。一种工具能够收集大多数患者报告的子领域（9/16，56%）。风险调整的最低数据收集包括患者人口统计学特征、病前功能、卒中类型和严重程度、血管和全身危险因素以及特定治疗/护理相关因素。
制定了一套共识性卒中测量标准集，作为一种简单、实用的方法来提高卒中护理的价值。在用于不同护理环境的监测和比较时，该标准集应在实践中进行验证。
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