title: Meeting the ambition of measuring the quality of hospitals' stroke care using routinely collected administrative data: a feasibility study.
abstract: OBJECTIVE
  To examine the potential for using routinely collected administrative data to compare the quality and safety of stroke care at a hospital level, including evaluating any bias due to variations in coding practice.
  
  
  METHODS
  A retrospective cohort study of English hospitals' performance against six process and outcome indicators covering the acute care pathway. We used logistic regression to adjust the outcome measures for case mix.
  
  
  METHODS
  Hospitals in England.
  
  
  METHODS
  Stroke patients (ICD-10 I60-I64) admitted to English National Health Service public acute hospitals between April 2009 and March 2010, accounting for 91 936 admissions.
  
  
  METHODS
  The quality and safety were measured using six indicators spanning the hospital care pathway, from timely access to brain scans to emergency readmissions following discharge after stroke.
  
  
  RESULTS
  There were 182 occurrences of hospitals performing statistically differently from the national average at the 99.8% significance level across the six indicators. Differences in coding practice appeared to only partially explain the variation.
  
  
  CONCLUSIONS
  Hospital administrative data provide a practical and achievable method for evaluating aspects of stroke care across the acute pathway. However, without improvements in coding and further validation, it is unclear whether the cause of the variation is the quality of care or the result of different local care pathways and data coding accuracy.
authors.affiliation: Dr Foster Unit, Department of Primary Care and Social Medicine, Imperial College London, London, UK. w.palmer07@imperial.ac.uk
authors.forename: William L
authors.initials: WL
authors.lastname: Palmer
authors.forename: Alex
authors.initials: A
authors.lastname: Bottle
authors.forename: Charlie
authors.initials: C
authors.lastname: Davie
authors.forename: Charles A
authors.initials: CA
authors.lastname: Vincent
authors.forename: Paul
authors.initials: P
authors.lastname: Aylin
mesh_terms: D004739:England; D006739:Hospital Administration / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013222:State Medicine / Q000706:statistics & numerical data; D020521:Stroke
keywords: measurement of quality; patient safety; quality indicators; safety indicators