Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University.
Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center Hospital.
Circ J. 2021 Jan 25;85(2):201-209. doi: 10.1253/circj.CJ-20-0639. Epub 2020 Nov 20.
In Japan there is no consensus on how to efficiently measure quality indicators (QIs), defined as a standard of care, for acute ischemic stroke (AIS). Using information from a health insurance claims database and electronic medical records, we evaluated the feasibility and validity of measuring QIs for AIS patients who received intravenous recombinant tissue plasminogen activator (IV rt-PA) or endovascular therapy (EVT).
AIS patients receiving rt-PA or EVT between 2013 and 2015 were identified. We selected 17 AIS QI measures for primary stroke centers (PSCs) and 8 for comprehensive stroke centers (CSCs). Defined QIs were calculated for each hospital and then averaged. In total, the data of 8,206 patients (rt-PA 83.7%, EVT 34.9%) from 172 hospitals were obtained. Median National Institute of Health Stroke Scale score at admission was 14, and 37.7% of the patients were functionally independent at discharge. All target QIs were successfully measured with fewer missing values, and the accuracy of preset data was about 90%. Adherence rates were low (<50%) in 5 QI measures among PSCs, including door-to-needle time ≤1 h, and in 1 QI measure among CSCs (door-to-brain and vascular imaging time ≤30 min).
Measuring QIs for AIS by this novel approach was feasible and reliable in the provision of a national benchmark.
在日本，对于如何有效地衡量急性缺血性脑卒中（AIS）的质量指标（QIs），即护理标准，尚未达成共识。本研究利用医疗保险索赔数据库和电子病历中的信息，评估了针对接受静脉重组组织型纤溶酶原激活剂（IV rt-PA）或血管内治疗（EVT）的 AIS 患者衡量 QIs 的可行性和有效性。
确定了 2013 年至 2015 年间接受 rt-PA 或 EVT 的 AIS 患者。我们选择了 17 项针对初级卒中中心（PSC）和 8 项针对综合卒中中心（CSC）的 AIS QI 衡量指标。为每个医院计算了定义的 QIs，然后取平均值。总共从 172 家医院获得了 8206 名患者（rt-PA 占 83.7%，EVT 占 34.9%）的数据。入院时的中位国立卫生研究院卒中量表评分（NIHSS）为 14，出院时 37.7%的患者具有独立功能。所有目标 QIs 都成功测量，缺失值较少，预设数据的准确率约为 90%。在 PSC 中，有 5 项 QI 衡量指标的达标率较低（<50%），包括门到针时间≤1 小时，在 CSC 中有 1 项 QI 衡量指标（门到脑和血管成像时间≤30 分钟）。
通过这种新方法衡量 AIS 的 QIs 在提供国家基准方面是可行和可靠的。
