PhD defence S.J. (Sanne) den Hartog

Dissertation in short:

The research presented in this thesis aimed to provide insight in the measurement and improvement of quality of ischemic stroke care by generic and (new) disease-specific quality indicators. We investigated the Standardized Mortality Ratio (SMR). SMRs are case-mix adjusted mortality rates per hospital and are used to evaluate quality of care. The current SMR measured on a hospital level, does not measure differences in quality of care between hospitals, but merely reflects differences in case-mix (disease severity) between hospitals. A regionally measured SMR could be a more valid quality indicator. Patient-reported experience measures (PREMs) are instruments assessing the patient’s perception of health care. For the measurement of patient experience of stroke care, a PREM with sufficient psychometric performance and practical feasibility is not yet available. Future research should focus on the development of more stroke-specific quality indicators, especially in the patient-reported outcomes and experiences. First pass reperfusion, defined as excellent reperfusion with thrombectomy in one pass, is associated with favorable functional outcome, independently of patient, imaging, and treatment characteristics. To be able to use FPR as a quality indicator, more research is needed on how to achieve FPR. Higher levels of interventionist’s experience – in particular, the number of patients treated in the preceding year – are associated with better outcomes after EVT, including more FPR. 
In quality improvement interventions, it is important to focus on the reduction of variation between and in particular within hospitals. A promising quality improvement intervention is the use of performance feedback.