Validation of intracerebral hemorrhage-specific intensity of care quality metrics

Given the considerable variation in care of patients with intracerebral hemorrhage (ICH) among centers that results in differences in outcome among these patients, a new intensity of care quality metrics has been proposed. This study aimed to validate the new ICH-specific intensity of care quality metrics.

A total of 50 consecutive patients with ICH who were admitted within 24 hours of symptom onset were identified. Twenty-six quality indicators related to 18 facets of care were incorporated into a metric providing the variable, definition of the variable, and quality parameter. A score of 1 point was assigned if the quality parameter met the threshold for appropriate performance or if the parameter was not applicable, creating a total score of up to 26 points. The predictive validity of the classification scheme was tested by using the bootstrap method.

Fourteen of the 50 patients with ICH died during hospitalization (28%). The intensity of care quality metric score ranged from 17 points to 26 points. The mean score was higher in those who survived compared with those who died (23 ± 3 vs 21 ± 2; P = .02). Survival increased with tertile based on higher scores (100%, 67%, and 55%; P = .017). The receiver operating characteristic curve demonstrated a high discriminating ability of intensity of care quality metrics for in-hospital mortality (0.730, 95% confidence interval, 0.591-0.869) and a C-statistic of 0.91 (95% confidence interval, 0.90-0.92).

Correlation of the new ICH-specific intensity of care quality metric with in-hospital mortality supports its broader use for improving and standardizing medical care among patients with ICH.