Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―

ataru nishimura; Kunihiro Nishimura; Daisuke Onozuka; Ryu Matsuo; Akiko Kada; Satoru Kamitani; Takahiro Higashi; Kuniaki Ogasawara; Megumi Shimodozono; Masafumi Harada; Yoichiro Hashimoto; Teruyuki Hirano; Haruhiko Hoshino; Ryo Itabashi; Yoshiaki Itoh; Toru Iwama; Tatsuo Kohriyama; Yuji Matsumaru; Toshiaki Osato; Makoto Sasaki; Yoshiaki Shiokawa; Hiroaki Shimizu; Hidehiro Takekawa; Toru Nishi; Masaaki Uno; Yoshiki Yagita; Keisuke Ido; Ai Kurogi; Ryota Kurogi; Koichi Arimura; Nice Ren; Akihito Hagihara; Shunya Takizawa; Hajime Arai; Takanari Kitazono; Susumu Miyamoto; Kazuo Minematsu; Koji Iihara

doi:10.1253/circj.CJ-19-0089

Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―

ataru nishimura, Kunihiro Nishimura, Daisuke Onozuka, Ryu Matsuo, Akiko Kada, Satoru Kamitani, Takahiro Higashi, Kuniaki Ogasawara, Megumi Shimodozono, Masafumi Harada, Yoichiro Hashimoto, Teruyuki Hirano, Haruhiko Hoshino, Ryo Itabashi, Yoshiaki Itoh, Toru Iwama, Tatsuo Kohriyama, Yuji Matsumaru, Toshiaki Osato, Makoto SasakiYoshiaki Shiokawa, Hiroaki Shimizu, Hidehiro Takekawa, Toru Nishi, Masaaki Uno, Yoshiki Yagita, Keisuke Ido, Ai Kurogi, Ryota Kurogi, Koichi Arimura, Nice Ren, Akihito Hagihara, Shunya Takizawa, Hajime Arai, Takanari Kitazono, Susumu Miyamoto, Kazuo Minematsu, Koji Iihara

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Pages (from-to)	2292-2302
Number of pages	11
Journal	Circulation Journal
Volume	83
Issue number	11
DOIs	https://doi.org/10.1253/circj.CJ-19-0089
Publication status	Published - 2019

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine

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10.1253/circj.CJ-19-0089

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nishimura, A., Nishimura, K., Onozuka, D., Matsuo, R., Kada, A., Kamitani, S., Higashi, T., Ogasawara, K., Shimodozono, M., Harada, M., Hashimoto, Y., Hirano, T., Hoshino, H., Itabashi, R., Itoh, Y., Iwama, T., Kohriyama, T., Matsumaru, Y., Osato, T., ... Iihara, K. (2019). Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―. Circulation Journal, 83(11), 2292-2302. https://doi.org/10.1253/circj.CJ-19-0089

nishimura, A, Nishimura, K, Onozuka, D, Matsuo, R, Kada, A, Kamitani, S, Higashi, T, Ogasawara, K, Shimodozono, M, Harada, M, Hashimoto, Y, Hirano, T, Hoshino, H, Itabashi, R, Itoh, Y, Iwama, T, Kohriyama, T, Matsumaru, Y, Osato, T, Sasaki, M, Shiokawa, Y, Shimizu, H, Takekawa, H, Nishi, T, Uno, M, Yagita, Y, Ido, K, Kurogi, A, Kurogi, R , Arimura, K, Ren, N, Hagihara, A, Takizawa, S, Arai, H, Kitazono, T, Miyamoto, S, Minematsu, K & Iihara, K 2019, 'Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―', Circulation Journal, vol. 83, no. 11, pp. 2292-2302. https://doi.org/10.1253/circj.CJ-19-0089

@article{883ec8ccf264451cbdda93d27b9b388e,

title = "Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―",

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.",

author = "ataru nishimura and Kunihiro Nishimura and Daisuke Onozuka and Ryu Matsuo and Akiko Kada and Satoru Kamitani and Takahiro Higashi and Kuniaki Ogasawara and Megumi Shimodozono and Masafumi Harada and Yoichiro Hashimoto and Teruyuki Hirano and Haruhiko Hoshino and Ryo Itabashi and Yoshiaki Itoh and Toru Iwama and Tatsuo Kohriyama and Yuji Matsumaru and Toshiaki Osato and Makoto Sasaki and Yoshiaki Shiokawa and Hiroaki Shimizu and Hidehiro Takekawa and Toru Nishi and Masaaki Uno and Yoshiki Yagita and Keisuke Ido and Ai Kurogi and Ryota Kurogi and Koichi Arimura and Nice Ren and Akihito Hagihara and Shunya Takizawa and Hajime Arai and Takanari Kitazono and Susumu Miyamoto and Kazuo Minematsu and Koji Iihara",

note = "Funding Information: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo (S.K., T. Higashi); Department of Neurosurgery (K.O.), Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (M. Sasaki), Iwate Medical University, Morioka; Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima (M. Shimodozono); Department of Radiology, Tokushima University Graduate School of Medical Sciences, Tokushima (M.H.); Department of Neurology, Kumamoto City Hospital, Kumamoto (Y.H.); Department of Stroke and Cerebrovascular Medicine (T. Hirano), Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo (H.H.); Department of Stroke Neurology, Kohnan Hospital, Sendai (R.I.); Department of Neurology, Graduate School of Medicine, Osaka City University, Osaka (Y.I.); Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu (T.I.); Brain Attack Center Ota Memorial Hospital, Fukuyama (T. Kohriyama); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba (Y.M.); Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo (T.O.); Department of Neurosurgery, Akita University Graduate School of Medicine, Akita (H.S.); Department of Neurology, Dokkyo Medical University, Tochigi (H.T.); Division of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto (T.N.), Department of Neurosurgery (M.U.); Department of Stroke Medicine (Y.Y.), Kawasaki Medical School, Kurashiki; Department of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Isehara (S.T.); Department of Neurosurgery, Juntendo University School of Medicine, Tokyo (H.A.); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (S.M.); and National Cerebral and Cardiovascular Center, Suita (K.M.), Japan Mailing address: Koji Iihara, MD, PhD, Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: kiihara@ns.med.kyushu-u.ac.jp ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Funding Information: This work was supported by the Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus managed by the Japan Agency for Medical Research and Development, Grants-in-Aid from the Japanese Ministry of Health, Labour and Welfare. The funding sources had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish. Funding Information: Received February 12, 2019; revised manuscript received August 7, 2019; accepted August 14, 2019; J-STAGE Advance Publication released online September 26, 2019 Time for primary review: 84 days Department of Neurosurgery (A.N., K. Ido, A. Kurogi, R.K., K.A., N.R., K. Iihara), Department of Health Care Administration and Management (R.M.), Department of Medicine and Clinical Science (T. Kitazono), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita (K.N.); Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka (D.O., A.H.); Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya (A. Kada); (Footnote continued the next page.) Funding Information: Dr. K. Nishimura reports honoraria from Philips Japan Co., Terumo Co. Dr. Kada reports membership of independent data monitoring committees of clinical trials taken by Bayer Yakuhin Ltd., outside the submitted work. Dr. Ogasawara reports consigned research funding from the Nihon Medi-Physics Co., Ltd. Dr. Hashimoto reports speaker fees from Bristol-Myers Squibb, Byer Yakuhin, Daiichi-Sankyo and Pfizer. Dr. Hirano reports lecture fees and honoraria from Bristol-Myers Squibb, Byer Yakuhin, Daiichi-Sankyo, Nippon Boehringer Ingelheim, Pfizer and Sanofi. Dr. Hoshino reports honoraria from Nippon Boehringer-Ingelheim Co., Ltd., Bayer Yakuhin Ltd., Daiichi-Sankyo Co., Ltd., Pfizer Inc. and Bristol-Myer Squibb Company Co., Ltd. Ryo Itabashi received honoraria for oral presentations from Bayer, Bristol-Myers Squibb, Takeda, Tanabe-Mitsubishi Parma, Daiichi-Sankyo, Boehringer-Ingelheim, Kowa Pharmaceutical Company, Otsuka Pharmaceutical, Sanofi, Pfizer, Stryker and Johnson and Johnson, and received research support not attributed in the manuscript from Tohoku Fukushi University. Dr. Matsumaru reports honoraria from Medtronic Japan, Stryker Japan, Terumo, Johnson & Johnson Japan, Medicos Hirata and Century Medical. Dr. Sasaki reports honoraria from Mitsubishi Tanabe Pharma Co., Actelion Pharmaceuticals, Eisai Co., Nihon Medi-Physics Co., Dai-ichi Sankyo, Bayer Healthcare, Otsuka Pharmaceutical, Boehringer-Ingelheim, Fujifilm Pharmaceuticals, Chugai Pharmaceutical Co. Ltd., and Hitachi Ltd. Dr. Takekawa reports honoraria from Dai-ichi Sankyo, Otsuka Pharmaceutical, Pfizer, speaker fees from Dai-ichi Sankyo, Bayer Healthcare, Otsuka Pharmaceutical, Pfizer, Bristol-Myers Squibb, Boehringer-Ingelheim, and Takeda Pharmaceutical. Dr. Yagita reports honoraria from Daiichi-Sankyo Co., Ltd. Dr. Takizawa reports grants from Daiichi-Sankyo Ltd. Dr. Arai reports grants from Eisai Co. Ltd., Fujitsu Limited, Kaneka Medix Corporation, Terumo Corporation, and Stryker Japan K.K. Medtronic Japan Co., and Software Service, Inc. Dr. Kitazono reports speaker fees from Bayer Yakuhin Ltd., and Daiichi-Sankyo Co. Ltd., consulting fees from Chugai Pharmaceutical Co. Ltd., and grant support from Takeda Pharmaceutical Co. Ltd., Daiichi-Sankyo Ltd., Mitsubishi Tanabe Pharma Co., Eisai Co. Ltd., Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., and MSD KK. Dr. Miyamoto reports grants from Carl Zeiss Meditec Co., Ltd., MIZUHO Corporation, Siemens Healthcare K.K., Philips Japan, Ltd., Brain Lab, Inc., Otsuka Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Nihon Medi-Physics Co., Ltd., Eisai Co., Ltd., CSL Behring Co., Mitsubishi Tanabe Pharma Co., Pfizer Co., Ltd., MSD Co., Ltd., Sanofi Co., Ltd., Medtronic Japan Co., Ltd., Dai-ichi Sankyo Co., Ltd., and Nihon Kohden Co., Ltd. Dr. Minematsu reports honoraria from Bayer Healthcare, Otsuka Pharmaceutical, Boehringer-Ingelheim, AstraZeneca, Pfizer, Mitsubishi Tanabe Pharma Cooperation, Japan Stryker, Kowa, Nihon Medi-Physics Co, BMS, Sawai Pharmaceutical Co., Sumitomo Dainippon Pharma Co. Ltd., Medico{\textquoteright}s Hirata, Dai-ichi Sankyo, Asteras Pharma, Kyowa Hakko Kirin Pharma, Inc., Sanofi S.A., MSD, Eisai Co., Nippon Chemiphar and Towa Pharmaceutical Co. Dr. Iihara reports grant support from AstraZeneca, Otsuka Pharmaceutical, Nihon Medi-Physics Co. The other authors report no conflicts. Publisher Copyright: {\textcopyright} 2019 Japanese Circulation Society. All rights reserved.",

year = "2019",

doi = "10.1253/circj.CJ-19-0089",

language = "English",

volume = "83",

pages = "2292--2302",

journal = "Circulation Journal",

issn = "1346-9843",

publisher = "Japanese Circulation Society",

number = "11",

}

TY - JOUR

T1 - Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―

AU - nishimura, ataru

AU - Nishimura, Kunihiro

AU - Onozuka, Daisuke

AU - Matsuo, Ryu

AU - Kada, Akiko

AU - Kamitani, Satoru

AU - Higashi, Takahiro

AU - Ogasawara, Kuniaki

AU - Shimodozono, Megumi

AU - Harada, Masafumi

AU - Hashimoto, Yoichiro

AU - Hirano, Teruyuki

AU - Hoshino, Haruhiko

AU - Itabashi, Ryo

AU - Itoh, Yoshiaki

AU - Iwama, Toru

AU - Kohriyama, Tatsuo

AU - Matsumaru, Yuji

AU - Osato, Toshiaki

AU - Sasaki, Makoto

AU - Shiokawa, Yoshiaki

AU - Shimizu, Hiroaki

AU - Takekawa, Hidehiro

AU - Nishi, Toru

AU - Uno, Masaaki

AU - Yagita, Yoshiki

AU - Ido, Keisuke

AU - Kurogi, Ai

AU - Kurogi, Ryota

AU - Arimura, Koichi

AU - Ren, Nice

AU - Hagihara, Akihito

AU - Takizawa, Shunya

AU - Arai, Hajime

AU - Kitazono, Takanari

AU - Miyamoto, Susumu

AU - Minematsu, Kazuo

AU - Iihara, Koji

N1 - Funding Information: Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo (S.K., T. Higashi); Department of Neurosurgery (K.O.), Division of Ultrahigh Field MRI, Institute for Biomedical Sciences (M. Sasaki), Iwate Medical University, Morioka; Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima (M. Shimodozono); Department of Radiology, Tokushima University Graduate School of Medical Sciences, Tokushima (M.H.); Department of Neurology, Kumamoto City Hospital, Kumamoto (Y.H.); Department of Stroke and Cerebrovascular Medicine (T. Hirano), Department of Neurosurgery (Y.S.), Kyorin University School of Medicine, Tokyo; Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo (H.H.); Department of Stroke Neurology, Kohnan Hospital, Sendai (R.I.); Department of Neurology, Graduate School of Medicine, Osaka City University, Osaka (Y.I.); Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu (T.I.); Brain Attack Center Ota Memorial Hospital, Fukuyama (T. Kohriyama); Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba (Y.M.); Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo (T.O.); Department of Neurosurgery, Akita University Graduate School of Medicine, Akita (H.S.); Department of Neurology, Dokkyo Medical University, Tochigi (H.T.); Division of Neurosurgery, Saiseikai Kumamoto Hospital, Kumamoto (T.N.), Department of Neurosurgery (M.U.); Department of Stroke Medicine (Y.Y.), Kawasaki Medical School, Kurashiki; Department of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Isehara (S.T.); Department of Neurosurgery, Juntendo University School of Medicine, Tokyo (H.A.); Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto (S.M.); and National Cerebral and Cardiovascular Center, Suita (K.M.), Japan Mailing address: Koji Iihara, MD, PhD, Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. E-mail: kiihara@ns.med.kyushu-u.ac.jp ISSN-1346-9843 All rights are reserved to the Japanese Circulation Society. For permissions, please e-mail: cj@j-circ.or.jp Funding Information: This work was supported by the Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus managed by the Japan Agency for Medical Research and Development, Grants-in-Aid from the Japanese Ministry of Health, Labour and Welfare. The funding sources had no role in the study design, data collection and analysis, manuscript preparation, or decision to publish. Funding Information: Received February 12, 2019; revised manuscript received August 7, 2019; accepted August 14, 2019; J-STAGE Advance Publication released online September 26, 2019 Time for primary review: 84 days Department of Neurosurgery (A.N., K. Ido, A. Kurogi, R.K., K.A., N.R., K. Iihara), Department of Health Care Administration and Management (R.M.), Department of Medicine and Clinical Science (T. Kitazono), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Statistics and Data Analysis, National Cerebral and Cardiovascular Center, Suita (K.N.); Department of Health Communication, Kyushu University Graduate School of Medical Sciences, Fukuoka (D.O., A.H.); Department of Clinical Research Management, National Hospital Organization Nagoya Medical Center, Nagoya (A. Kada); (Footnote continued the next page.) Funding Information: Dr. K. Nishimura reports honoraria from Philips Japan Co., Terumo Co. Dr. Kada reports membership of independent data monitoring committees of clinical trials taken by Bayer Yakuhin Ltd., outside the submitted work. Dr. Ogasawara reports consigned research funding from the Nihon Medi-Physics Co., Ltd. Dr. Hashimoto reports speaker fees from Bristol-Myers Squibb, Byer Yakuhin, Daiichi-Sankyo and Pfizer. Dr. Hirano reports lecture fees and honoraria from Bristol-Myers Squibb, Byer Yakuhin, Daiichi-Sankyo, Nippon Boehringer Ingelheim, Pfizer and Sanofi. Dr. Hoshino reports honoraria from Nippon Boehringer-Ingelheim Co., Ltd., Bayer Yakuhin Ltd., Daiichi-Sankyo Co., Ltd., Pfizer Inc. and Bristol-Myer Squibb Company Co., Ltd. Ryo Itabashi received honoraria for oral presentations from Bayer, Bristol-Myers Squibb, Takeda, Tanabe-Mitsubishi Parma, Daiichi-Sankyo, Boehringer-Ingelheim, Kowa Pharmaceutical Company, Otsuka Pharmaceutical, Sanofi, Pfizer, Stryker and Johnson and Johnson, and received research support not attributed in the manuscript from Tohoku Fukushi University. Dr. Matsumaru reports honoraria from Medtronic Japan, Stryker Japan, Terumo, Johnson & Johnson Japan, Medicos Hirata and Century Medical. Dr. Sasaki reports honoraria from Mitsubishi Tanabe Pharma Co., Actelion Pharmaceuticals, Eisai Co., Nihon Medi-Physics Co., Dai-ichi Sankyo, Bayer Healthcare, Otsuka Pharmaceutical, Boehringer-Ingelheim, Fujifilm Pharmaceuticals, Chugai Pharmaceutical Co. Ltd., and Hitachi Ltd. Dr. Takekawa reports honoraria from Dai-ichi Sankyo, Otsuka Pharmaceutical, Pfizer, speaker fees from Dai-ichi Sankyo, Bayer Healthcare, Otsuka Pharmaceutical, Pfizer, Bristol-Myers Squibb, Boehringer-Ingelheim, and Takeda Pharmaceutical. Dr. Yagita reports honoraria from Daiichi-Sankyo Co., Ltd. Dr. Takizawa reports grants from Daiichi-Sankyo Ltd. Dr. Arai reports grants from Eisai Co. Ltd., Fujitsu Limited, Kaneka Medix Corporation, Terumo Corporation, and Stryker Japan K.K. Medtronic Japan Co., and Software Service, Inc. Dr. Kitazono reports speaker fees from Bayer Yakuhin Ltd., and Daiichi-Sankyo Co. Ltd., consulting fees from Chugai Pharmaceutical Co. Ltd., and grant support from Takeda Pharmaceutical Co. Ltd., Daiichi-Sankyo Ltd., Mitsubishi Tanabe Pharma Co., Eisai Co. Ltd., Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., and MSD KK. Dr. Miyamoto reports grants from Carl Zeiss Meditec Co., Ltd., MIZUHO Corporation, Siemens Healthcare K.K., Philips Japan, Ltd., Brain Lab, Inc., Otsuka Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Nihon Medi-Physics Co., Ltd., Eisai Co., Ltd., CSL Behring Co., Mitsubishi Tanabe Pharma Co., Pfizer Co., Ltd., MSD Co., Ltd., Sanofi Co., Ltd., Medtronic Japan Co., Ltd., Dai-ichi Sankyo Co., Ltd., and Nihon Kohden Co., Ltd. Dr. Minematsu reports honoraria from Bayer Healthcare, Otsuka Pharmaceutical, Boehringer-Ingelheim, AstraZeneca, Pfizer, Mitsubishi Tanabe Pharma Cooperation, Japan Stryker, Kowa, Nihon Medi-Physics Co, BMS, Sawai Pharmaceutical Co., Sumitomo Dainippon Pharma Co. Ltd., Medico’s Hirata, Dai-ichi Sankyo, Asteras Pharma, Kyowa Hakko Kirin Pharma, Inc., Sanofi S.A., MSD, Eisai Co., Nippon Chemiphar and Towa Pharmaceutical Co. Dr. Iihara reports grant support from AstraZeneca, Otsuka Pharmaceutical, Nihon Medi-Physics Co. The other authors report no conflicts. Publisher Copyright: © 2019 Japanese Circulation Society. All rights reserved.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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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UR - http://www.scopus.com/inward/citedby.url?scp=85074184780&partnerID=8YFLogxK

U2 - 10.1253/circj.CJ-19-0089

DO - 10.1253/circj.CJ-19-0089

M3 - Article

C2 - 31554766

AN - SCOPUS:85074184780

SN - 1346-9843

VL - 83

SP - 2292

EP - 2302

JO - Circulation Journal

JF - Circulation Journal

IS - 11

ER -

Development of quality indicators of stroke centers and feasibility of their measurement using a nationwide insurance claims database in Japan ― J-ASPECT study ―

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