{"id":17006,"date":"2023-11-13T15:32:12","date_gmt":"2023-11-13T20:32:12","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=17006"},"modified":"2023-11-16T15:40:38","modified_gmt":"2023-11-16T20:40:38","slug":"change-in-hospital-risk-standardized-stroke-mortality-performance","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/change-in-hospital-risk-standardized-stroke-mortality-performance\/","title":{"rendered":"Change in hospital risk-standardized stroke mortality performance with and without the passive surveillance stroke severity score"},"content":{"rendered":"<p><strong>Background<\/strong> &mdash; Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke.<\/p>\n<p><strong>Methods<\/strong> &mdash; We used linked administrative data to identify adults who were hospitalized with ischemic stroke or intracerebral hemorrhage across 157 hospitals in Ontario, Canada between 2014 and 2019. We fitted a random effects logistic regression model using Markov Chain Monte Carlo methods to estimate hospital-specific 30-day RSMR and 95% credible intervals with adjustment for age, sex, Charlson comorbidity index, and stroke type. In a separate model, we additionally adjusted for stroke severity using PaSSV. Hospitals were defined as low-performing, average-performing, or high-performing depending on whether the RSMR and 95% credible interval were above, overlapping, or below the cohort\u2019s crude mortality rate.<\/p>\n<p><strong>Results<\/strong> &mdash; We identified 65,082 patients [48.0% were female, the median age (25th,75th percentiles) was 76 years (65,84), and 86.4% had an ischemic stroke]. The crude 30-day all-cause mortality rate was 14.1%. The inclusion of PaSSV in the model reclassified 18.5% (n=29) of the hospitals. Of the 143 hospitals initially classified as average-performing, after adjustment for PaSSV, 20 were reclassified as high-performing and 8 were reclassified as low-performing. Of the 4 hospitals initially classified as low-performing, 1 was reclassified as high-performing. All 10 hospitals initially classified as high-performing remained unchanged.<\/p>\n<p><strong>Conclusion<\/strong> &mdash; PaSSV may be useful for risk-adjusting mortality when comparing hospital performance. External validation of our findings in other jurisdictions is needed.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &mdash; Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting for the Passive Surveillance Stroke SeVerity (PaSSV) score, a measure of stroke severity derived using administrative data, changed hospital-specific estimated 30-day risk-standardized mortality rate (RSMR) after stroke. Methods &mdash; We used linked administrative data to identify [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[24,40,63],"migration-helper-qa-sample-set":[],"class_list":["post-17006","journal_article","type-journal_article","status-publish","hentry","topic-acute-and-emergency-services","topic-cardiovascular-disease","topic-decision-science"],"acf":{"citation":"Yu AYX, Kapral MK, Park AL, Fang J, Hill MD, Kamal N, Field TS, Joundi RA, Peterson S, Zhao Y, Austin PC. <em>Med Care<\/em>. 2023; Nov 13 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1097\/mlr.0000000000001944","ices_scientist":[1385,1298,1150,13135],"site":[6733],"research_program":[6742],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Change in hospital risk-standardized stroke mortality performance with and without the passive surveillance stroke severity score<\/title>\n<meta name=\"description\" content=\"Background &mdash; Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. We evaluated whether adjusting\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/change-in-hospital-risk-standardized-stroke-mortality-performance\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Change in hospital risk-standardized stroke mortality performance with and without the passive surveillance stroke severity score\" \/>\n<meta property=\"og:description\" content=\"Background &mdash; Adjustment for baseline stroke severity is necessary for accurate assessment of hospital performance. 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