Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

doi:10.1186/s12883-017-0815-4

. 2017 Feb 28;17(1):46.

doi: 10.1186/s12883-017-0815-4.

Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

Akiko Kada¹, Kunihiro Nishimura², Jyoji Nakagawara³, Kuniaki Ogasawara⁴, Junichi Ono⁵, Yoshiaki Shiokawa⁶, Toru Aruga⁷, Shigeru Miyachi⁸, Izumi Nagata⁹, Kazunori Toyoda¹⁰, Shinya Matsuda¹¹, Akifumi Suzuki¹², Hiroharu Kataoka¹³, Fumiaki Nakamura², Satoru Kamitani¹⁴, Koji Iihara¹⁵; J-ASPECT Study Collaborators

Affiliations

¹ Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan. akiko.kada@nnh.go.jp.
² Center for Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
⁵ Chiba Cardiovascular Center, Ichihara, Japan.
⁶ Department of Neurosurgery, Kyorin University, Mitaka, Japan.
⁷ Showa University, Tokyo, Japan.
⁸ Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
⁹ Kokura Memorial Hospital, Fukuoka, Japan.
¹⁰ Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
¹¹ Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kita-Kyushu, Japan.
¹² Akita Prefectural Hospital Organization Research Institute for Brain and Blood Vessels, Akita, Japan.
¹³ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁴ Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁵ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 28241749
PMCID: PMC5330137
DOI: 10.1186/s12883-017-0815-4

Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

Akiko Kada et al. BMC Neurol. 2017.

. 2017 Feb 28;17(1):46.

doi: 10.1186/s12883-017-0815-4.

Authors

Affiliations

¹ Department of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan. akiko.kada@nnh.go.jp.
² Center for Cardiovascular Disease Information, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Suita, Japan.
⁴ Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
⁵ Chiba Cardiovascular Center, Ichihara, Japan.
⁶ Department of Neurosurgery, Kyorin University, Mitaka, Japan.
⁷ Showa University, Tokyo, Japan.
⁸ Department of Neurosurgery, Osaka Medical College, Takatsuki, Japan.
⁹ Kokura Memorial Hospital, Fukuoka, Japan.
¹⁰ Departments of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
¹¹ Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kita-Kyushu, Japan.
¹² Akita Prefectural Hospital Organization Research Institute for Brain and Blood Vessels, Akita, Japan.
¹³ Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan.
¹⁴ Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁵ Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

PMID: 28241749
PMCID: PMC5330137
DOI: 10.1186/s12883-017-0815-4

Abstract

Background: Although the Brain Attack Coalition recommended establishing centers of comprehensive care for stroke and cerebrovascular disease patients, a scoring system for such centers was lacking. We created and validated a comprehensive stroke center (CSC) score, adapted to Japanese circumstances.

Methods: Of the selected 1369 certified training institutions in Japan, 749 completed an acute stroke care capabilities survey. Hospital performance was determined using a 25-item score, evaluating 5 subcategories: personnel, diagnostic techniques, specific expertise, infrastructure, and education. Consistency and validity were examined using correlation coefficients and factorial analysis.

Results: The CSC score (median, 14; interquartile range, 11-18) varied according to hospital volume. The five subcategories showed moderate consistency (Cronbach's α = 0.765). A strong correlation existed between types of available personnel and specific expertise. Using the 2011 Japanese Diagnosis Procedure Combination database for patients hospitalized with stroke, four constructs were identified by factorial analysis (neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and neurocritical care and rehabilitation) that affected in-hospital mortality from ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The total CSC score was related to in-hospital mortality from ischemic stroke (odds ratio [OR], 0.973; 95% confidence interval [CI], 0.958-0.989), intracerebral hemorrhage (OR, 0.970; 95% CI, 0.950-0.990), and subarachnoid hemorrhage (OR, 0.951; 95% CI, 0.925-0.977), with varying contributions from the four constructs.

Conclusions: The CSC score is a valid measure for assessing CSC capabilities, based on the availability of neurovascular surgery and intervention, vascular neurology, diagnostic neuroradiology, and critical care and rehabilitation services.

Keywords: Cerebrovascular circulation; Hemorrhage; Ischemia; Risk factors; Stroke.

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References

1. Alberts MJ, Hademenos G, Latchaw RE, Jagoda A, Marler JR, Mayberg MR, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA. 2000;283:3102–3109. doi: 10.1001/jama.283.23.3102. - DOI - PubMed
1. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36:1597–1616. doi: 10.1161/01.STR.0000170622.07210.b4. - DOI - PubMed
1. Reeves MJ, Parker C, Fonarow GC, Smith EE, Schwamm LH. Development of stroke performance measures: definitions, methods, and current measures. Stroke. 2010;41:1573–1578. doi: 10.1161/STROKEAHA.109.577171. - DOI - PubMed
1. Leifer D, Bravata DM, Connors JJ, 3rd, Hinchey JA, Jauch EC, Johnston SC, et al. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:849–877. doi: 10.1161/STR.0b013e318208eb99. - DOI - PubMed
1. Markovchick VJ, Moore EE. Optimal trauma outcome: trauma system design and the trauma team. Emerg Med Clin North Am. 2007;25:643–654. doi: 10.1016/j.emc.2007.07.002. - DOI - PubMed

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[1] Alberts MJ, Hademenos G, Latchaw RE, Jagoda A, Marler JR, Mayberg MR, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA. 2000;283:3102–3109. doi: 10.1001/jama.283.23.3102. - DOI - PubMed

[2] Alberts MJ, Hademenos G, Latchaw RE, Jagoda A, Marler JR, Mayberg MR, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. JAMA. 2000;283:3102–3109. doi: 10.1001/jama.283.23.3102. - DOI - PubMed

[3] Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36:1597–1616. doi: 10.1161/01.STR.0000170622.07210.b4. - DOI - PubMed

[4] Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke. 2005;36:1597–1616. doi: 10.1161/01.STR.0000170622.07210.b4. - DOI - PubMed

[5] Reeves MJ, Parker C, Fonarow GC, Smith EE, Schwamm LH. Development of stroke performance measures: definitions, methods, and current measures. Stroke. 2010;41:1573–1578. doi: 10.1161/STROKEAHA.109.577171. - DOI - PubMed

[6] Reeves MJ, Parker C, Fonarow GC, Smith EE, Schwamm LH. Development of stroke performance measures: definitions, methods, and current measures. Stroke. 2010;41:1573–1578. doi: 10.1161/STROKEAHA.109.577171. - DOI - PubMed

[7] Leifer D, Bravata DM, Connors JJ, 3rd, Hinchey JA, Jauch EC, Johnston SC, et al. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:849–877. doi: 10.1161/STR.0b013e318208eb99. - DOI - PubMed

[8] Leifer D, Bravata DM, Connors JJ, 3rd, Hinchey JA, Jauch EC, Johnston SC, et al. Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to Brain Attack Coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:849–877. doi: 10.1161/STR.0b013e318208eb99. - DOI - PubMed

[9] Markovchick VJ, Moore EE. Optimal trauma outcome: trauma system design and the trauma team. Emerg Med Clin North Am. 2007;25:643–654. doi: 10.1016/j.emc.2007.07.002. - DOI - PubMed

[10] Markovchick VJ, Moore EE. Optimal trauma outcome: trauma system design and the trauma team. Emerg Med Clin North Am. 2007;25:643–654. doi: 10.1016/j.emc.2007.07.002. - DOI - PubMed

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Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

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Development and validation of a score for evaluating comprehensive stroke care capabilities: J-ASPECT Study

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