Abstract
Objective: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). Methods: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. Results: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). Conclusion: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.
| Original language | English |
|---|---|
| Pages (from-to) | 502-508 |
| Number of pages | 7 |
| Journal | European Journal of Vascular and Endovascular Surgery |
| Volume | 60 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Oct 2020 |
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A Composite Measure for Quality of Care in Patients with Symptomatic Carotid Stenosis Using Textbook Outcome. / Dutch Audit for Carotid Interventions (DACI) Collaborators.
In: European Journal of Vascular and Endovascular Surgery, Vol. 60, No. 4, 10.2020, p. 502-508.Research output: Contribution to journal › Article › Academic › peer-review
TY - JOUR
T1 - A Composite Measure for Quality of Care in Patients with Symptomatic Carotid Stenosis Using Textbook Outcome
AU - Kuhrij, Laurien S.
AU - Karthaus, Eleonora G.
AU - Vahl, Anco C.
AU - Willems, Martine C.M.
AU - Elshof, Jan W.
AU - de Borst, Gert J.
AU - Van den Akker, P. J.
AU - Akkersdijk, G. J.
AU - Akkersdijk, G. P.
AU - Akkersdijk, W. L.
AU - van Andringa de Kempenaer, M. G.
AU - Arts, C. H.
AU - Avontuur, J. A.
AU - Bakker, O. J.
AU - Balm, R.
AU - Barendregt, W. B.
AU - Bekken, J. A.
AU - Bender, M. H.
AU - Bendermacher, B. L.
AU - van den Berg, M.
AU - Berger, P.
AU - Beuk, R. J.
AU - Blankensteijn, J. D.
AU - Bleker, R. J.
AU - Blok, J. J.
AU - Bode, A. S.
AU - Bodegom, M. E.
AU - van der Bogt, K. E.
AU - Boll, A. P.
AU - Booster, M. H.
AU - Borger van der Burg, B. L.
AU - de Borst, G. J.
AU - Bos-van Rossum, W. T.
AU - Bosma, J.
AU - Botman, J. M.
AU - Bouwman, L. H.
AU - Brehm, V.
AU - de Bruijn, M. T.
AU - de Bruin, J. L.
AU - Brummel, P.
AU - van Brussel, J. P.
AU - Buijk, S. E.
AU - Buijs, M. A.
AU - Buimer, M. G.
AU - Burger, D. H.
AU - Buscher, H. C.
AU - Cancrinus, E.
AU - Castenmiller, P. H.
AU - Cazander, G.
AU - Coester, A. M.
AU - Cuypers, P. H.
AU - Daemen, J. H.
AU - Dawson, I.
AU - Dierikx, J. E.
AU - Dijkstra, M. L.
AU - Diks, J.
AU - Dinkelman, M. K.
AU - Dirven, M.
AU - Dolmans, D. E.
AU - van Doorn, R. C.
AU - van Dortmont, L. M.
AU - Drouven, J. W.
AU - van der Eb, M. M.
AU - Eefting, D.
AU - van Eijck, G. J.
AU - Elshof, J. W.
AU - Elsman, B. H.
AU - van der Elst, A.
AU - van Engeland, M. I.
AU - van Eps, R. G.
AU - Faber, M. J.
AU - de Fijter, W. M.
AU - Fioole, B.
AU - Fokkema, T. M.
AU - Frans, F. A.
AU - Fritschy, W. M.
AU - Fung Kon Jin, P. H.
AU - Geelkerken, R. H.
AU - van Gent, W. B.
AU - Glade, G. J.
AU - Govaert, B.
AU - Groenendijk, R. P.
AU - de Groot, H. G.
AU - van den Haak, R. F.
AU - de Haan, E. F.
AU - Hajer, G. F.
AU - Hamming, J. F.
AU - van Hattum, E. S.
AU - Hazenberg, C. E.
AU - Hedeman Joosten, P. P.
AU - Helleman, J. N.
AU - van der Hem, L. G.
AU - Hendriks, J. M.
AU - van Herwaarden, J. A.
AU - Heyligers, J. M.
AU - Hinnen, J. W.
AU - Hissink, R. J.
AU - Ho, G. H.
AU - den Hoed, P. T.
AU - Hoedt, M. T.
AU - van Hoek, F.
AU - Hoencamp, R.
AU - Hoffmann, W. H.
AU - Hogendoorn, W.
AU - Hoksbergen, A. W.
AU - Hollander, E. J.
AU - Hommes, M.
AU - Hopmans, C. J.
AU - Huisman, L. C.
AU - Hulsebos, R. G.
AU - Huntjens, K. M.
AU - Idu, M. M.
AU - Jacobs, M. J.
AU - van der Jagt, M. F.
AU - Jansbeken, J. R.
AU - Janssen, R. J.
AU - Jiang, H. H.
AU - de Jong, S. C.
AU - Jongbloed-Winkel, T. A.
AU - Jongkind, V.
AU - Kapma, M. R.
AU - Keller, B. P.
AU - Khodadade Jahrome, A.
AU - Kievit, J. K.
AU - Klemm, P. L.
AU - Klinkert, P.
AU - Koedam, N. A.
AU - Koelemaij, M. J.
AU - Kolkert, J. L.
AU - Koning, G. G.
AU - Koning, O. H.
AU - Konings, R.
AU - Krasznai, A. G.
AU - Krol, R. M.
AU - Kropman, R. H.
AU - Kruse, R. R.
AU - van der Laan, L.
AU - van der Laan, M. J.
AU - van Laanen, J. H.
AU - van Lammeren, G. W.
AU - Lamprou, D. A.
AU - Lardenoye, J. H.
AU - Lauret, G. J.
AU - Leenders, B. J.
AU - Legemate, D. A.
AU - Leijdekkers, V. J.
AU - Lemson, M. S.
AU - Lensvelt, M. M.
AU - Lijkwan, M. A.
AU - Lind, R. C.
AU - van der Linden, F. T.
AU - Liqui Lung, P. F.
AU - Loos, M. J.
AU - Loubert, M. C.
AU - van de Luijtgaarden, K. M.
AU - Mahmoud, D. E.
AU - Manshanden, C. G.
AU - Mattens, E. C.
AU - Meerwaldt, R.
AU - Mees, B. M.
AU - von Meijenfeldt, G. C.
AU - Menting, T. P.
AU - Metz, R.
AU - Minnee, R. C.
AU - de Mol van Otterloo, J. C.
AU - Molegraaf, M. J.
AU - Montauban van Swijndregt, Y. C.
AU - Morak, M. J.
AU - van de Mortel, R. H.
AU - Mulder, W.
AU - Nagesser, S. K.
AU - Naves, C. C.
AU - Nederhoed, J. H.
AU - Nevenzel-Putters, A. M.
AU - de Nie, A. J.
AU - Nieuwenhuis, D. H.
AU - Nieuwenhuizen, J.
AU - van Nieuwenhuizen, R. C.
AU - Nio, D.
AU - Noyez, V. J.
AU - Oomen, A. P.
AU - Oranen, B. I.
AU - Oskam, J.
AU - Palamba, H. W.
AU - Peppelenbosch, A. G.
AU - van Petersen, A. S.
AU - Petri, B. J.
AU - Pierie, M. E.
AU - Ploeg, A. J.
AU - Pol, R. A.
AU - Ponfoort, E. D.
AU - Post, I. C.
AU - Poyck, P. P.
AU - Prent, A.
AU - ten Raa, S.
AU - Raymakers, J. T.
AU - Reichart, M.
AU - Reichmann, B. L.
AU - Reijnen, M. M.
AU - de Ridder, J. A.
AU - Rijbroek, A.
AU - van Rijn, M. J.
AU - de Roo, R. A.
AU - Rouwet, E. V.
AU - Saleem, B. R.
AU - Salemans, P. B.
AU - van Sambeek, M. R.
AU - Samyn, M. G.
AU - van ’t Sant, H. P.
AU - van Schaik, J.
AU - van Schaik, P. M.
AU - Scharn, D. M.
AU - Scheltinga, M. R.
AU - Schepers, A.
AU - Schlejen, P. M.
AU - Schlosser, F. J.
AU - Schol, F. P.
AU - Scholtes, V. P.
AU - Schouten, O.
AU - Schreve, M. A.
AU - Schurink, G. W.
AU - Sikkink, C. J.
AU - te Slaa, A.
AU - Smeets, H. J.
AU - Smeets, L.
AU - Smeets, R. R.
AU - de Smet, A. A.
AU - Smit, P. C.
AU - Smits, T. M.
AU - Snoeijs, M. G.
AU - Sondakh, A. O.
AU - Speijers, M. J.
AU - van der Steenhoven, T. J.
AU - van Sterkenburg, S. M.
AU - Stigter, D. A.
AU - Stokmans, R. A.
AU - Strating, R. P.
AU - Stultiëns, G. N.
AU - Sybrandy, J. E.
AU - Teijink, J. A.
AU - Telgenkamp, B. J.
AU - Teraa, M.
AU - Testroote, M. J.
AU - Tha-In, T.
AU - The, R. M.
AU - Thijsse, W. J.
AU - Thomassen, I.
AU - Tielliu, I. F.
AU - van Tongeren, R. B.
AU - Toorop, R. J.
AU - Tournoij, E.
AU - Truijers, M.
AU - Türkcan, K.
AU - Tutein Nolthenius, R. P.
AU - Ünlü,
AU - Vaes, R. H.
AU - Vafi, A. A.
AU - Vahl, A. C.
AU - Veen, E. J.
AU - Veger, H. T.
AU - Veldman, M. G.
AU - Velthuis, S.
AU - Verhagen, H. J.
AU - Verhoeven, B. A.
AU - Vermeulen, C. F.
AU - Vermeulen, E. G.
AU - Vierhout, B. P.
AU - van der Vijver-Coppen, R. J.
AU - Visser, M. J.
AU - van der Vliet, J. A.
AU - Vlijmen - van Keulen, C. J.
AU - Voorhoeve, R.
AU - van der Vorst, J. R.
AU - Vos, A. W.
AU - de Vos, B.
AU - Vos, C. G.
AU - Vos, G. A.
AU - Voute, M. T.
AU - Vriens, B. H.
AU - Vriens, P. W.
AU - de Vries, A. C.
AU - de Vries, D. K.
AU - de Vries, J. P.
AU - de Vries, M.
AU - van der Waal, C.
AU - Waasdorp, E. J.
AU - Wallis de Vries, B. M.
AU - van Walraven, L. A.
AU - van Wanroij, J. L.
AU - Warlé, M. C.
AU - van de Water, W.
AU - van Weel, V.
AU - van Well, A. M.
AU - Welten, G. M.
AU - Welten, R. J.
AU - Wever, J. J.
AU - Wiersema, A. M.
AU - Wikkeling, O. R.
AU - Willaert, W. I.
AU - Wille, J.
AU - Willems, M. C.
AU - Willigendael, E. M.
AU - Wilschut, E. D.
AU - Wisselink, W.
AU - Witte, M. E.
AU - Wittens, C. H.
AU - Wong, C. Y.
AU - Wouda, R.
AU - Yazar, O.
AU - Yeung, K. K.
AU - Zeebregts, C. J.
AU - van Zeeland, M. L.
AU - Dutch Audit for Carotid Interventions (DACI) Collaborators
PY - 2020/10
Y1 - 2020/10
N2 - Objective: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). Methods: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. Results: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). Conclusion: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.
AB - Objective: Composite measures may better objectify hospital performance than individual outcome measures (IOM). Textbook outcome (TO) is an outcome measure achieved for an individual patient when all undesirable outcomes are absent. The aim of this study was to assess TO as an additional outcome measure to evaluate quality of care in symptomatic patients treated by carotid endarterectomy (CEA). Methods: All symptomatic patients treated by CEA in 2018, registered in the Dutch Audit for Carotid Interventions, were included. TO was defined as a composite of the absence of 30 day mortality, neurological events (any stroke or transient ischaemic attack [TIA]), cranial nerve deficit, haemorrhage, 30 day readmission, prolonged length of stay (LOS; > 5 days) and any other surgical complication. Multivariable logistic regression was used to identify covariables associated with achieving TO, which were used for casemix adjustment for hospital comparison. For each hospital, an observed vs. expected number of events ratio (O/E ratio) was calculated and plotted in a funnel plot with 95% control limits. Results: In total, 70.7% of patients had a desired outcome within 30 days after CEA and therefore achieved TO. Prolonged LOS was the most common parameter (85%) and mortality the least common (1.1%) for not achieving TO. Covariates associated with achieving TO were younger age, the absence of pulmonary comorbidity, higher haemoglobin levels, and TIA as index event. In the case mix adjusted funnel plot, the O/E ratios between hospitals ranged between 0.63 and 1.27, with two hospitals revealing a statistically significantly lower rate of TO (with O/E ratios of 0.63 and 0.66). Conclusion: In the Netherlands, most patients treated by CEA achieve TO. Variation between hospitals in achieving TO might imply differences in performance. TO may be used as an additive to the pre-existing IOM, especially in surgical care with low baseline risk such as CEA.
KW - Carotid endarterectomy
KW - Outcome
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=85088789183&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2020.06.012
DO - 10.1016/j.ejvs.2020.06.012
M3 - Article
C2 - 32732140
AN - SCOPUS:85088789183
VL - 60
SP - 502
EP - 508
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
SN - 1078-5884
IS - 4
ER -