Journal Article

Value-based healthcare in ischemic stroke care: case-mix adjustment models for clinical and patient-reported outcomes

Hilkens, Pieter H. E., Hazelzet, Jan A., van Leeuwen, Nikki, Dippel, Diederik W. J., de Groot, Aafke J., Venema, Esmee, Limburg, Martien, Wijffels, Markus P., de Leeuw, Frank-Erik, Oemrawsingh, Arvind, Lingsma, Hester F., Voogdt-Pruis, Helene R., Bakker, Carla H.

2019

Overview

Background Patient-Reported Outcome Measures (PROMs) have been proposed for benchmarking health care quality across hospitals, which requires extensive case-mix adjustment. The current study’s aim was to develop and compare case-mix models for mortality, a functional outcome, and a patient-reported outcome measure (PROM) in ischemic stroke care. Methods Data from ischemic stroke patients, admitted to four stroke centers in the Netherlands between 2014 and 2016 with available outcome information ( N  = 1022), was analyzed. Case-mix adjustment models were developed for mortality, modified Rankin Scale (mRS) scores and EQ-5D index scores with respectively binary logistic, proportional odds and linear regression models with stepwise backward selection. Predictive ability of these models was determined with R-squared (R 2 ) and area-under-the-receiver-operating-characteristic-curve (AUC) statistics. Results Age, NIHSS score on admission, and heart failure were the only common predictors across all three case-mix adjustment models. Specific predictors for the EQ-5D index score were sex (β = 0.041), socio-economic status (β = − 0.019) and nationality (β = − 0.074). R 2 -values for the regression models for mortality (5 predictors), mRS score (9 predictors) and EQ-5D utility score (12 predictors), were respectively R 2  = 0.44, R 2  = 0.42 and R 2  = 0.37. Conclusions The set of case-mix adjustment variables for the EQ-5D at three months differed considerably from the set for clinical outcomes in stroke care. The case-mix adjustment variables that were specific to this PROM were sex, socio-economic status and nationality. These variables should be considered in future attempts to risk-adjust for PROMs during benchmarking of hospitals.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Benchmarking / Business metrics / Case-mix / Clinical outcomes / Comorbidity / Data analysis / Health care / Health Sciences / Heart failure / Ischemia / Ischemic stroke / Medical care quality / Medicine / Medicine & Public Health / Mortality / Netherlands / Patient outcomes / Patient-reported outcome measure / Patients / Proms (Parties) / Quality of life / Regression analysis / Research Article / Risk adjustment model / Social class / Statistical analysis / Statistical Theory and Methods / Statistics / statistics and modelling / Statistics for Life Sciences / Stroke / Stroke patients / Tariffs / Theory of Medicine/Bioethics / Value-based healthcare / Variables