Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough

Table 2 Quality of care indicators of all 17 intervention centers in the Netherlands

	N (%) / Median (IQR) in total population (missing excluded)	Center-level range (median or percentage)	Total number of patients	Missing N (%)	P-value*
Structure
Center volume			3279	0
2014	187 (6^a)	0–18			< 0.001
2015	822 (25)	1–13			< 0.001
2016	1131 (34)	1–14			< 0.001
2017	1139 (35)	0.3–13			< 0.001
Processes
Time from arrival at the ED to groin puncture in non-transferred patients (min)	90 (70–119)	74–125	1292	203 (6.2)	< 0.001
Time from arrival at the ED to groin puncture in transferred patients (min)	39 (26–57)	20–60	1722	61 (1.9)	< 0.001
Use of general anesthesia	778 (25)	0–99	3082	197 (6.0)	< 0.001
Outcome
Modified Rankin Scale (mRS) score at 90 days			3065	214 (6.5)	< 0.001
mRS 0 (No symptoms)	209 (7)	1–18
mRS 1 (No significant disability)	471 (15)	7–26
mRS 2 (Slight disability)	561 (18)	4–29
mRS 3 (Moderate disability)	404 (13)	4–20
mRS 4 (Moderately severe disability)	366 (12)	7–31
mRS 5 (Severe disability)	168 (6)	2–11
mRS 6 (Dead)	886 (29)	21–36

IQR Interquartile range, ED Emergency department, EVT endovascular treatment
^aPercentage of all EVT patients treated in the Netherlands in that year (see Fig. 1 for details)
*P-value is based on comparison between 17 centers using a non-parametric Kruskal Wallis test for continuous variables or Pearson’s chi-square statistic for categorical variables
See Supplementary Table 1 for details of quality of care indicators in each intervention center

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