https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)61448-2.pdf

Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison.

Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study) : a prospective population-based sequential comparison. Commentery

Observational studies often provide the only available information about treatment effects. Control of confounding, however, remains challenging. The authors compared five methods for evaluating the effect of tissue plasminogen activator on death among 6,269 ischemic stroke patients registered in a German stroke registry: multivariable logistic regression, propensity score–matched analysis, regression adjustment with the propensity score, and two propensity score–based weighted methods—one estimating the treatment effect in the entire study population (inverseprobability-of-treatment weights), another in the treated population (standardized-mortality-ratio weights). Between 2000 and 2001, 212 patients received tissue plasminogen activator. The crude odds ratio between tissue plasminogen activator and death was 3.35 (95% confidence interval: 2.28, 4.91). The adjusted odds ratio depended strongly on the adjustment method, ranging from 1.11 (95% confidence interval: 0.67, 1.84) for the standardized-mortality-ratio weighted to 10.77 (95% confidence interval: 2.47, 47.04) for the inverse-probability-of-treatment-weighted analysis. For treated patients with a low propensity score, risks of dying were high. Exclusion of patients with a propensity score of <5% yielded comparable odds ratios of approximately 1 for all methods. High levels of nonuniform treatment effect render summary estimates very sensitive to the weighting system explicit or implicit in an adjustment technique. Researchers need to be clear about the population for which an overall treatment estimate is most suitable. causality; cerebrovascular accident; confounding factors (epidemiology); data interpretation, statistical; logistic models; models, statistical; observational study

/pdf/results-of-multivariable-logistic-regression-propensity-3s7rd2jcbv.pdf

Results of Multivariable Logistic Regression, Propensity Matching, Propensity Adjustment, and Propensity-based Weighting under Conditions of Nonuniform Effect

This summary makes the case for performance measurement as key tool for policy-makers endeavouring to improve health systems in the European Region. It highlights the various elements required of a comprehensive health system performance measurement framework; pinpoints how performance measurement can be used in practice; and stresses the role of government stewardship in securing improved performance. It reviews existing evidence and provides examples of the empirical application of performance measures, demonstrating that if governments invest in health they can expect those resources to be used well.

https://www.who.int/management/district/performance/PerformanceMeasurementHealthSystemImprovement2.pdf

Performance measurement for health system improvement : experiences, challenges and prospects

Background There is a lack of information about factors associated with in-hospital death and the impact of neurological complications on early outcome for patients with stroke treated in community settings. We investigated predictors for in-hospital mortality and attributable risks of death after ischemic stroke in a pooled analysis of large German stroke registers. Methods Stroke patients admitted to hospitals cooperating within the German Stroke Registers Study Group (ADSR) between January 1, 2000, and December 31, 2000, were analyzed. The ADSR is a network of regional stroke registers, combining data from 104 academic and community hospitals throughout Germany. The impact of patients' demographic and clinical characteristics, their comorbid conditions, and the treating hospital expertise in stroke care on in-hospital mortality was analyzed using Cox regression analysis. Attributable risks of death for medical and neurological complications were calculated. Results A total of 13 440 ischemic stroke patients were included. Overall in-hospital mortality was 4.9%. In women, higher age ( P P Conclusions Substantial differences were found in the impact of comorbid conditions on early outcome for men and women. Programs aiming at an improvement in short-term outcome after stroke should focus especially on a reduction of pneumonia and an early treatment of increased intracranial pressure.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/217308/ioi30426.pdf

Predictors of In-Hospital Mortality and Attributable Risks of Death After Ischemic Stroke The German Stroke Registers Study Group

ContextData are limited regarding the risks and benefits of thrombolytic therapy
for acute ischemic stroke outside of clinical trials.ObjectiveTo investigate predictors of in-hospital mortality in patients with
ischemic stroke treated with intravenous tissue plasminogen activator (tPA)
within a pooled analysis of large German stroke registers.Design and SettingProspective, observational cohort study conducted at 225 community and
academic hospitals throughout Germany cooperating within the German Stroke
Registers Study Group.PatientsA total of 1658 patients with acute ischemic stroke who were admitted
to study hospitals between 2000 and 2002 and were treated with tPA.Main Outcome MeasureIn-hospital mortality.ResultsOne hundred sixty-six patients (10%) who received tPA died during hospitalization,
with 67.5% of these deaths occurring within 7 days. Factors predicting in-hospital
death after tPA use were older age (for each 10-year increment in age, adjusted
odds ratio [OR], 1.6; 95% confidence interval [CI], 1.3-1.9) and altered level
of consciousness (adjusted OR, 3.4; 95% CI, 2.4-4.7). The overall rate of
symptomatic intracranial hemorrhage was 7.1% and increased with age. One or
more serious complications was observed in 27.2% of all patients and in 83.9%
of patients who died after tPA treatment. An inverse relation between the
number of patients treated with tPA in the respective hospital and the risk
of in-hospital death was observed (adjusted OR, 0.97; 95% CI, 0.96-0.99 for
each additional patient treated with tPA per year).ConclusionIn patients with ischemic stroke who are treated with tPA, disturbances
of consciousness and increasing age are associated with increased in-hospital
mortality.

/pdf/predictors-of-in-hospital-mortality-in-patients-with-acute-1sqh5zp02k.pdf

Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy

Background and purpose: Comparable, standardised data on the quality and efficiency of stroke care in Germany are lacking. The Arbeitsgemeinschaft Deutscher Schlaganfall-Register (ADSR - German Stroke Registries Study Group) has defined a Minimum DataSet for the evaluation of quality indicators of stroke treatment in Germany. Methods: The ADSR is a voluntary network of current regional stroke registries aiming at a standardisation in the use of stroke terminology and methods of data collection for German stroke databases. Currently six regional stroke registries are cooperating in the ADSR, combining data from about 18000 stroke patients in 110 hospitals annually. Results: In the design of the ADSR DataSet a modular approach was chosen. The ADSR Minimum DataSet was adapted for a wide use in different health care facilities. In addition to the Minimum DataSet an Advanced DataSet will be developed to document additional items of stroke care in specialised stroke centres. The ADSR DataSet collection will be completed by special Extended DataSets, designed for answering centre-specific and research questions. Conclusion: The ADSR Minimum DataSet allows a standardised assessment of stroke care in Germany. It is the first questionnaire that provides valid and reliable comparisons between different clinical settings as well as regional stroke databases. The ADSR Minimum DataSet defines core items for a future National German Health Report on stroke care.

Qualitätssicherung in der Schlaganfall-Behandlung: das Basismodul der Arbeitsgemeinschaft Deutscher Schlaganfall-Register (ADSR)

Background and purpose Comparable, standardised data on the quality and efficiency of stroke care in Germany are lacking. The Arbeitsgemeinschaft Deutscher Schlaganfall-Register (ADSR--German Stroke Registries Study Group) has defined a "Minimum DataSet" for the evaluation of quality indicators of stroke treatment in Germany. Methods The ADSR is a voluntary network of current regional stroke registries aiming at a standardisation in the use of stroke terminology and methods of data collection for German stroke databases. Currently six regional stroke registries are cooperating in the ADSR, combining data from about 18,000 stroke patients in 110 hospitals annually. Results In the design of the ADSR DataSet a modular approach was chosen. The ADSR "Minimum DataSet" was adapted for a wide use in different health care facilities. In addition to the "Minimum DataSet" an "Advanced DataSet" will be developed to document additional items of stroke care in specialised stroke centres. The ADSR DataSet collection will be completed by special "Extended DataSets", designed for answering centre-specific and research questions. Conclusion The ADSR "Minimum DataSet" allows a standardised assessment of stroke care in Germany. It is the first questionnaire that provides valid and reliable comparisons between different clinical settings as well as regional stroke databases. The ADSR "Minimum DataSet" defines core items for a future National German Health Report on stroke care.

[Quality assurance in treatment of stroke: basic module of the German Stroke Registry Study Group].

Monitoring quality of stroke care in Germany: the minimum DataSet of the German Stroke Registries Study Group (ADSR)

Einflussfaktoren und zeitliche Veränderung der intravenösen Thrombolysebehandlung beim Hirninfarkt in Deutschland. Ergebnisse der Arbeitsgemeinschaft Deutscher Schlaganfall Register (ADSR)

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