title: Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.
abstract: BACKGROUND
  The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.
  
  
  METHODS
  We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions.
  
  
  RESULTS
  All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers.
  
  
  CONCLUSIONS
  Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.
authors: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Maryse C
authors: MC
authors: Cnossen
authors: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Suzanne
authors: S
authors: Polinder
authors: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Hester F
authors: HF
authors: Lingsma
authors: Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
authors: Andrew I R
authors: AI
authors: Maas
authors: Division of Anaesthesia, University of Cambridge/Addenbrooke's Hospital, Cambridge, United Kingdom.
authors: David
authors: D
authors: Menon
authors: Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Ewout W
authors: EW
authors: Steyerberg
mesh_terms: D000070642:Brain Injuries, Traumatic; D057186:Comparative Effectiveness Research; D005060:Europe; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007557:Israel; D007902:Length of Stay; D008137:Longitudinal Studies; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014193:Trauma Centers / Q000706:statistics & numerical data