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            "title": "Establishing Standard Performance Measures for Adult Stroke Patients: A Nationwide Inpatient Sample Database Study",
            "creators": [
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                    "creatorType": "author",
                    "firstName": "Maryam",
                    "lastName": "Rahman"
                },
                {
                    "creatorType": "author",
                    "firstName": "Dan",
                    "lastName": "Neal"
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                {
                    "creatorType": "author",
                    "firstName": "Kyle M",
                    "lastName": "Fargen"
                },
                {
                    "creatorType": "author",
                    "firstName": "Brian L",
                    "lastName": "Hoh"
                }
            ],
            "abstractNote": "BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital acquired conditions (HACs) are used to evaluate the safety and quality of healthcare provided by healthcare systems and individual facilities.\nOBJECTIVE: To better understand the incidence of these events in hospitalized stroke patients, we determined the rates of PSIs and HACs among patients with a diagnosis of stroke in the Nationwide Inpatient Sample (NIS) database.\nMETHODS: We queried the NIS for all hospitalizations involving ischemic stroke. We determined the incidence of various PSIs and HACs by searching the hospital records for ICD-9 codes indicating each PSI or HAC. Statistical analysis was performed with SAS.\nRESULTS: There were 903,647 hospitalizations involving stroke in the NIS database for years 2002-2010. Among these hospitalizations a total of 137,161 (15.2%) patients experienced one or more AHRQ PSI. The most common PSIs included postoperative respiratory failure (9.44%), sepsis (4.43%), and pressure ulcer (2.19%). A total of 28,323 (3.13%) of stroke patients experienced one or more HAC. The most common HACs included falls and trauma (2.51%) and stage III & IV pressure ulcers (0.43%). Increasing comorbidity score (p≤0.001) was associated with increased likelihood of all PSIs and HACs. Presence of PSI or HAC resulted in increased length of stay, increased hospital charges and an increase in mortality rates (p<0.0001).\nCONCLUSION: Our results estimate baseline national incidence rates of PSIs and HACs in stroke patients. These data may be used to determine individual institutional improvements or success by comparison.",
            "publicationTitle": "World neurosurgery",
            "publisher": "",
            "place": "",
            "date": "Aug 28, 2013",
            "volume": "",
            "issue": "",
            "section": "",
            "partNumber": "",
            "partTitle": "",
            "pages": "",
            "series": "",
            "seriesTitle": "",
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            "journalAbbreviation": "World Neurosurg",
            "DOI": "10.1016/j.wneu.2013.08.024",
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            "url": "",
            "accessDate": "",
            "PMID": "",
            "PMCID": "",
            "ISSN": "1878-8750",
            "archive": "",
            "archiveLocation": "",
            "shortTitle": "Establishing Standard Performance Measures for Adult Stroke Patients",
            "language": "ENG",
            "libraryCatalog": "NCBI PubMed",
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            "rights": "",
            "extra": "PMID: 23994132",
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            "dateAdded": "2013-09-12T19:44:37Z",
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            "itemType": "journalArticle",
            "title": "Performance of the EuroSCORE models in emergency cardiac surgery",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Stuart W",
                    "lastName": "Grant"
                },
                {
                    "creatorType": "author",
                    "firstName": "Graeme L",
                    "lastName": "Hickey"
                },
                {
                    "creatorType": "author",
                    "firstName": "Ioannis",
                    "lastName": "Dimarakis"
                },
                {
                    "creatorType": "author",
                    "firstName": "Graham",
                    "lastName": "Cooper"
                },
                {
                    "creatorType": "author",
                    "firstName": "David P",
                    "lastName": "Jenkins"
                },
                {
                    "creatorType": "author",
                    "firstName": "Rakesh",
                    "lastName": "Uppal"
                },
                {
                    "creatorType": "author",
                    "firstName": "Iain",
                    "lastName": "Buchan"
                },
                {
                    "creatorType": "author",
                    "firstName": "Ben",
                    "lastName": "Bridgewater"
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            ],
            "abstractNote": "BACKGROUND: Accurate risk-adjustment models are useful for clinical decision making and are important for minimizing any tendency toward risk-averse clinical practice. In cardiac surgery, emergency patients are potentially at greatest risk of inappropriate risk-averse clinical decisions. UK cardiac surgery outcomes are currently risk-adjusted with EuroSCORE models. The objective of this study was to assess the performance of the EuroSCORE models in emergency cardiac surgery.\nMETHODS AND RESULTS: The National Institute for Cardiovascular Outcomes Research database was used to identify adult cardiac surgery procedures performed in the United Kingdom between April 2008 and March 2011. A subset of procedures (July 2010-March 2011) was used for EuroSCORE II validation. The outcome measure was in-hospital mortality. Model calibration (Hosmer-Lemeshow test, calibration plots, calculation of calibration intercept and slope) and discrimination (area under receiver-operating characteristic curve [area under the curve]) were assessed. In total, 109 988 cardiac procedures at 41 hospitals were included, of which 3342 were defined as emergency procedures. Compared with performance in all cardiac surgery and nonemergency cardiac surgery, the logistic EuroSCORE and EuroSCORE II models had poorer discrimination (area under the curve, 0.703 and 0.690, respectively) and poorer calibration for emergency surgery. The EuroSCORE risk factors of female sex, chronic pulmonary disease, neurological disease, active endocarditis, unstable angina, recent myocardial infarction, and pulmonary hypertension were not identified as important risk factors for emergency cardiac surgery.\nCONCLUSIONS: Both EuroSCORE models demonstrated poor calibration and comparatively poor discrimination for emergency cardiac surgery. This has important implications when these models are used for clinical decision making or to adjust governance analyses.",
            "publicationTitle": "Circulation. Cardiovascular quality and outcomes",
            "publisher": "",
            "place": "",
            "date": "Mar 1, 2013",
            "volume": "6",
            "issue": "2",
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            "partNumber": "",
            "partTitle": "",
            "pages": "178-185",
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            "journalAbbreviation": "Circ Cardiovasc Qual Outcomes",
            "DOI": "10.1161/CIRCOUTCOMES.111.000018",
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            "url": "",
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            "PMID": "",
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            "ISSN": "1941-7705",
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            "language": "eng",
            "libraryCatalog": "NCBI PubMed",
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            "extra": "PMID: 23463809",
            "tags": [
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                    "tag": "Aged",
                    "type": 1
                },
                {
                    "tag": "Area Under Curve",
                    "type": 1
                },
                {
                    "tag": "Cardiac Surgical Procedures",
                    "type": 1
                },
                {
                    "tag": "Chi-Square Distribution",
                    "type": 1
                },
                {
                    "tag": "Decision Support Techniques",
                    "type": 1
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                {
                    "tag": "Discriminant Analysis",
                    "type": 1
                },
                {
                    "tag": "Emergencies",
                    "type": 1
                },
                {
                    "tag": "Female",
                    "type": 1
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                {
                    "tag": "Great Britain",
                    "type": 1
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                {
                    "tag": "Hospital Mortality",
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                {
                    "tag": "Humans",
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                    "tag": "Logistic Models",
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                    "tag": "Quality Indicators, Health Care",
                    "type": 1
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                {
                    "tag": "ROC Curve",
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                    "tag": "Risk Assessment",
                    "type": 1
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                    "tag": "Risk Factors",
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                {
                    "tag": "Time Factors",
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            "creatorSummary": "Leleu et al.",
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        "data": {
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            "version": 3,
            "itemType": "journalArticle",
            "title": "Hospital performance based on treatment delays: comparison of ranking methods",
            "creators": [
                {
                    "creatorType": "author",
                    "firstName": "Henri",
                    "lastName": "Leleu"
                },
                {
                    "creatorType": "author",
                    "firstName": "Frédéric",
                    "lastName": "Capuano"
                },
                {
                    "creatorType": "author",
                    "firstName": "Gérard",
                    "lastName": "Nitenberg"
                },
                {
                    "creatorType": "author",
                    "firstName": "Lydie",
                    "lastName": "Travental"
                },
                {
                    "creatorType": "author",
                    "firstName": "Etienne",
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            ],
            "abstractNote": "BACKGROUND: Reducing time-to-care is crucial in many acute and chronic diseases. Quality indicators based on target delays derived from guidelines are used to compare hospital performance but there is no accepted methodology for comparing performance when no target delay has been established.\nAIM: To explore by different statistical methods the uncertainty in hospital comparisons that are based on delay indicators, when no target delay is available.\nMETHODS: Data for hospital door-to-needle time were extracted from a 2010 study of 1699 patients in 57 hospitals with ST-elevated myocardial infarction. We determined whether the times in each hospital were statistically different from the overall mean time or the median time for all hospitals by (i) one-way analysis of variance (ANOVA), (ii) non-parametric ANOVA with Nelson-Hsu adjustment (ANOVA R) and (iii) the proportional hazard model (PHM). We also tested for the assumptions underlying the methods: normal distribution for ANOVA, homogeneity of variances (homoscedasticity) for ANOVA and ANOVA R, and proportionality for PHM.\nRESULTS: Door-to-needle times were available for 889 patients in 44 hospitals. Data distribution was not Gaussian. Test assumptions were verified for ANOVA R (homoscedasticity) for one data subset (>48-h times (48H) excluded) and for PHM (proportionality) for two data subsets (48H or >95th percentile (P95) times excluded). The same five significantly better performers were identified in each case (although ANOVA R missed one). ANOVA R (48H) identified two significantly poorer performers, PHM (48H) identified three and PHM (P95) just one. Poorer performers differed according to method.\nCONCLUSIONS: The tested statistical methods yielded broadly similar results but no method was truly satisfactory. A transparency statement should therefore always specify the ranking method used to compare hospital performance.",
            "publicationTitle": "BMJ quality & safety",
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            "date": "Aug 6, 2013",
            "volume": "",
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            "journalAbbreviation": "BMJ Qual Saf",
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            "url": "",
            "accessDate": "",
            "PMID": "",
            "PMCID": "",
            "ISSN": "2044-5423",
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            "shortTitle": "Hospital performance based on treatment delays",
            "language": "ENG",
            "libraryCatalog": "NCBI PubMed",
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            "extra": "PMID: 23922404",
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            "publicationTitle": "The journal of trauma and acute care surgery",
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                    "creatorType": "author",
                    "firstName": "Megan",
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                    "creatorType": "author",
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            "abstractNote": "STUDY OBJECTIVE: Medicare's new, mandatory Hospital Inpatient Value-Based Purchasing Program introduces financial rewards or penalties to hospitals according to achievement or improvement on several publicly reported quality measures. Our objective was to describe hospital reporting on the 4 emergency department (ED)-related program measures, variation in performance on the ED measures across hospital characteristics, and the characteristics of hospitals that were more likely to receive performance scores based on improvement versus achievement.\nMETHODS: This was an exploratory, descriptive analysis. We merged 2008 to 2010 performance data from Hospital Compare with the 2009 American Hospital Association Annual Survey. We calculated a composite score for the 4 ED measures and used Kruskal-Wallis tests to examine differences in performance across hospital characteristics. We also examined differences in the percentage of scores that were awarded according to improvement versus achievement.\nRESULTS: There were 2,927 hospitals that qualified for the value-based purchasing program and were included in the analysis. For-profit hospitals received the highest scores; public hospitals and hospitals lacking The Joint Commission (TJC) accreditation received the lowest scores. Public hospitals had the largest share of scores awarded according to improvement (39.8%); for-profit hospitals had the lowest (27.8%).\nCONCLUSION: We found variation in performance by hospital characteristics on the ED-related program measures. Although public and non-TJC-accredited hospitals trailed in performance, they showed strong signs of improvement, signaling that performance gaps by ownership and accreditation may decrease. Considering the increasing scope of the value-based purchasing program, ED leaders should monitor both achievement and improvement on the 4 ED-related program measures.",
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