title: Comparisons of risk-adjusted clinical outcomes for patients with aneurysmal subarachnoid haemorrhage across eight teaching hospitals in Japan.
abstract: OBJECTIVE
  To assess predictive value of patient characteristics and severity of aneurysmal subarachnoid haemorrhage (SAH) patients for clinical outcomes, and thereby estimate risk-adjusted clinical outcomes and compare the outcomes across hospitals.
  
  
  METHODS
  We selected 256 aneurysmal SAH patients from eight teaching hospitals in Japan. The clinical outcomes of patients at the time of discharge were assessed by the Glasgow Outcome Scale (GOS). A multiple logistic regression analysis was performed to identify predictors for the GOS status at the time of discharge. The risk-adjusted proportion of patients with a favourable GOS outcome was then estimated for each facility and compared across hospitals.
  
  
  RESULTS
  The logistic regression analysis revealed that younger age (P < 0.001), patients with good World Federations of Neurological Surgeons grade at admission (P < 0.001) and absence of chronic renal failure or ischaemic heart disease as a comorbid condition (P < 0.001) were identified as significant predictors for favourable GOS outcome at the time of discharge among aneurysmal SAH patients (C statistic = 0.88). We found that one hospital had significantly better outcomes than the others.
  
  
  CONCLUSIONS
  After comparison of risk-adjusted values across hospitals, the clinical management methods of the hospital that showed the best performance were examined and shared among providers.
authors: Department of Healthcare Economics and Quality Management, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors: Tatsuro
authors: T
authors: Ishizaki
authors: Yuichi
authors: Y
authors: Imanaka
authors: Miho
authors: M
authors: Sekimoto
authors: Haruhisa
authors: H
authors: Fukuda
authors: Hanako
authors: H
authors: Mihara
mesh_terms: D000368:Aged; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D020379:Risk Adjustment; D013345:Subarachnoid Hemorrhage / Q000628:therapy