Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Stroke
Development of Quality Indicators of Stroke Centers and Feasibility of Their Measurement Using a Nationwide Insurance Claims Database in Japan ― J-ASPECT Study ―
Ataru NishimuraKunihiro NishimuraDaisuke OnozukaRyu MatsuoAkiko KadaSatoru KamitaniTakahiro HigashiKuniaki OgasawaraMegumi ShimodozonoMasafumi HaradaYoichiro HashimotoTeruyuki HiranoHaruhiko HoshinoRyo ItabashiYoshiaki ItohToru IwamaTatsuo KohriyamaYuji MatsumaruToshiaki OsatoMakoto SasakiYoshiaki ShiokawaHiroaki ShimizuHidehiro TakekawaToru NishiMasaaki UnoYoshiki YagitaKeisuke IdoAi KurogiRyota KurogiKoichi ArimuraNice RenAkihito HagiharaShunya TakizawaHajime AraiTakanari KitazonoSusumu MiyamotoKazuo MinematsuKoji Iihara
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Supplementary material

2019 Volume 83 Issue 11 Pages 2292-2302

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Abstract

Background:We aimed to develop quality indicators (QIs) related to primary and comprehensive stroke care and examine the feasibility of their measurement using the existing Diagnosis Procedure Combination (DPC) database.

Methods and Results:We conducted a systematic review of domestic and international studies using the modified Delphi method. Feasibility of measuring the QI adherence rates was examined using a DPC-based nationwide stroke database (396,350 patients admitted during 2013–2015 to 558 hospitals participating in the J-ASPECT study). Associations between adherence rates of these QIs and hospital characteristics were analyzed using hierarchical logistic regression analysis. We developed 17 and 12 measures as QIs for primary and comprehensive stroke care, respectively. We found that measurement of the adherence rates of the developed QIs using the existing DPC database was feasible for the 6 QIs (primary stroke care: early and discharge antithrombotic drugs, mean 54.6% and 58.7%; discharge anticoagulation for atrial fibrillation, 64.4%; discharge antihypertensive agents, 51.7%; comprehensive stroke care: fasudil hydrochloride or ozagrel sodium for vasospasm prevention, 86.9%; death complications of diagnostic neuroangiography, 0.4%). We found wide inter-hospital variation in QI adherence rates based on hospital characteristics.

Conclusions:We developed QIs for primary and comprehensive stroke care. The DPC database may allow efficient data collection at low cost and decreased burden to evaluate the developed QIs.

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© 2019 THE JAPANESE CIRCULATION SOCIETY
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