====== Quality indicators ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1jue2dFuI_LDj0oQVaot1srtJ-kiuy7desUyoX-eEchqHeBsYk/?limit=15&utm_campaign=pubmed-2&fc=20230710074544}} ---- Medical institutions use [[quality metrics]] to track [[complications]] seen in hospital [[admission]]s. Similarly, [[morbidity and mortality conference]]s are held to [[peer review]]. ---- Quality indicators are measurable criteria or standards used to assess the quality of a product, service, process, or outcome. They are often used in various fields, including healthcare, manufacturing, software development, education, and customer service, to monitor and improve performance. Quality indicators help organizations evaluate their performance, identify areas for improvement, and track progress towards desired goals. Here are some examples of quality indicators in different domains: Healthcare: [[Patient satisfaction]] rates [[Hospital readmission]] rates [[Infection]] rates Medication error rates [[Mortality]] rates Length of [[hospital stay]] Education: Graduation rates Standardized test scores Student attendance rates Dropout rates Teacher-student ratio Student engagement levels Customer Service: Average response time to customer inquiries Customer satisfaction scores First-call resolution rates Net Promoter Score (NPS) Customer retention rates ---- Quality [[indicator]]s (QIs) are an accepted [[tool]] for measuring a [[hospital]]'s [[performance]] in routine [[care]]. ---- [[Quality]] metrics are a key component of an effective quality management plan and are the measurements used in ensuring customers receive acceptable products or deliverables. Quality metrics are used to directly translate customer needs into acceptable performance measures in both products and processes. ---- Medical institutions use [[quality metrics]] to track [[complications]] seen in hospital [[admission]]s. Similarly, [[morbidity and mortality conference]]s are held to [[peer review]] complications. ---- The National Quality Indicators are generally divided into three main types of [[quality]] [[measure]]s: Structure indicators ([[framework]]s and [[resource]]s, [[competence]], available [[equipment]], registers, etc.) Process indicators (activities in the patient process, e.g., diagnostics, treatment) ---- In neurosurgery, several [[quality]] indicators have been discussed in the past, i.e., [[readmission]] and [[reoperation]] rates, rates of [[nosocomial]] and [[surgical site infection]]s, and overall [[length of stay]], among others ((Dasenbrock HH, Liu KX, Devine CA, Chavakula V, Smith TR, Gormley WB, Dunn IF (2015) Length of hospital stay after craniotomy for tumor: a National Surgical Quality Improvement Program analysis. Neurosurg Focus 39:E12. https://doi.org/10. 3171/2015.10.FOCUS15386)) ((McLaughlin N, Jin P, Martin NA (2015) Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement. J Neurosurg 123:198–205. https://doi.org/10.3171/2014.9.JNS14666)) ((Moghavem N, Morrison D, Ratliff JK, Hernandez-Boussard T (2015) Cranial neurosurgical 30-day readmissions by clinical indication. J Neurosurg 123:189–197. https://doi.org/10.3171/2014.12. JNS14447)) ((Mukerji N, Jenkins A, Nicholson C, Mitchell P (2012) Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator. J Neurosurg Pediatr 9: 665–669. https://doi.org/10.3171/2012.2.PEDS11305)). ((Sarda S, Bookland M, Chu J, Shoja MM, Miller MP, Reisner SB, Yun PH, Chern JJ (2014) Return to system within 30 days of discharge following pediatric non-shunt surgery. J Neurosurg Pediatr 14:654–661. https://doi.org/10.3171/2014.8.PEDS14109)) ((Schipmann S, Akalin E, Doods J, Ewelt C, Stummer W, Suero Molina E (2016) When the infection hits the wound: matched case-control study in a neurosurgical patient collective including systematic literature review and risk factors analysis. World Neurosurg 95:178–189. https://doi.org/10.1016/j.wneu. 2016.07.093)) ((Schipmann S, Schwake M, Suero Molina E, Roeder N, Steudel WI, Warneke N, Stummer W (2017) Quality indicators in cranial neurosurgery: which are presently substantiated? A systematic review. World Neurosurg 104:104–112. https://doi.org/10.1016/j.wneu. 2017.03.111)) ((Shah MN, Stoev IT, Sanford DE, Gao F, Santiago P, Jaques DP, Dacey RG Jr (2013) Are readmission rates on a neurosurgical service indicators of quality of care? J Neurosurg 119:1043–1049.https://doi.org/10.3171/2013.3.JNS121769)). While these indicators are easy to register, their clinical [[value]] remains questionable ---- ---- Ren et al. examined national [[trend]]s in adherence to the QIs developed by the Close The Gap-Stroke program by combining [[data]] from the health [[insurance]] claims [[database]] and [[electronic medical record]]s, and the [[association]] between adherence to these QIs and early [[acute ischemic stroke outcome]] in [[Japan]] patients In a study, patients with [[acute ischemic stroke]] who received acute [[reperfusion therapy]] in 351 Close The Gap-Stroke-participating hospitals were analyzed retrospectively. The primary outcomes were changes in trends for adherence to the defined QIs by difference-in-difference analysis and the effects of adherence to distinct QIs on in-hospital outcomes at the individual level. A mixed [[logistic regression]] model was adjusted for patient and hospital characteristics (eg, age, sex, number of beds) and hospital units as random effects. Between 2013 and 2017, 21 651 patients (median age, 77 years; 43.0% female) were assessed. Of the 25 defined measures, marked and sustainable improvement in the adherence rates were observed for a [[door-to-needle time]], [[door-to-puncture time]], proper use of [[endovascular thrombectomy]], and successful [[revascularization]]. The in-[[Hospital mortality]] rate was 11.6%. Adherence to 14 QIs lowered the [[odds]] of in-[[Hospital mortality]] (odds ratio [95% CI], door-to-needle <60 min, 0.80 [0.69-0.93], door-to-puncture <90 min, 0.80 [0.67-0.96], successful revascularization, 0.40 [0.34-0.48]), and adherence to 11 QIs increased the odds of functional independence ([[modified Rankin Scale]] [[score]] 0-2) at [[discharge]]. They demonstrated national marked and sustainable [[improvement]] in adherence to [[door-to-needle time]], [[door-to-puncture time]], and successful [[reperfusion]] from 2013 to 2017 in [[Japan]] in patients with [[acute ischemic stroke]]. Adhering to the key QIs substantially affected in-hospital [[outcome]]s, underlining the importance of [[monitoring]] the [[quality of care]] using evidence-based QIs and the nationwide Close The Gap-Stroke program ((Ren N, Ogata S, Kiyoshige E, Nishimura K, Nishimura A, Matsuo R, Kitazono T, Higashi T, Ogasawara K, Iihara K; Close The Gap-Stroke, J-ASPECT Study Collaborators. Associations Between Adherence to Evidence-Based, Stroke Quality Indicators and Outcomes of Acute Reperfusion Therapy. Stroke. 2022 Aug 16:101161STROKEAHA121038483. doi: 10.1161/STROKEAHA.121.038483. Epub ahead of print. PMID: 35971841.)).