Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Marzyeh Amini; Sanne J den Hartog; Nikki van Leeuwen; Frank Eijkenaar; Laurien S Kuhrij; Lotte J Stolze; Paul J Nederkoorn; Hester F Lingsma; Adriaan C G M van Es; Ido R van den Wijngaard; Aad van der Lugt; Diederik W J Dippel; Bob Roozenbeek; PERFEQTOS Investigators

doi:10.1186/s13063-021-05819-z

Performance feedback on the quality of care in hospitals performing thrombectomy for ischemic stroke (PERFEQTOS): protocol of a stepped wedge cluster randomized trial

Trials. 2021 Dec 4;22(1):870. doi: 10.1186/s13063-021-05819-z.

Authors

Marzyeh Amini¹, Sanne J den Hartog^{1

2

3}, Nikki van Leeuwen¹, Frank Eijkenaar⁴, Laurien S Kuhrij^{5

6}, Lotte J Stolze^{5

6}, Paul J Nederkoorn⁶, Hester F Lingsma¹, Adriaan C G M van Es⁷, Ido R van den Wijngaard^{8

9}, Aad van der Lugt³, Diederik W J Dippel², Bob Roozenbeek^{10

11}; PERFEQTOS Investigators

Collaborators

PERFEQTOS Investigators:
Bob Roozenbeek, Sanne J den Hartog, Diederik W J Dippel, Aad van der Lugt, Hester F Lingsma, Nikki van Leeuwen, Laurien S Kuhrij, Lotte J Stolze, Paul J Nederkoorn, Adriaan C G M van Es, Ido R van den Wijngaard, Paula M Janssen, Pieter-Jan van Doormaal, Yvo B W E M Roos, Bart J Emmer, Suzanne M Silvis, Wouter Dinkelaar, Michel J M Remmers, Douwe L D Vos, Rob A R Gons, Lonneke S F Yo, Julia H van Tuijl, Hans Kortman, Jelis Boiten, Geert J Lycklama À Nijeholt, Jurgen R Piet, Wouter Stomp, Heleen M den Hertog, H Zwenneke Flach, Nyika D Kruyt, Marianne A A van Walderveen, Wim H van Zwam, Robert J van Oostenbrugge, Jasper M Martens, Jeannette Hofmeijer, H Bart van der Worp, Rob T H Lo

Affiliations

¹ Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
² Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
³ Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
⁵ Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
⁶ Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands.
⁷ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Department of Neurology, Haaglanden Medical Center, the Hague, The Netherlands.
⁹ Department of Radiology, Haaglanden Medical Center, the Hague, The Netherlands.
¹⁰ Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. [email protected].
¹¹ Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands. [email protected].

Abstract

Background: Although the provision of performance feedback to healthcare professionals based on data from quality registries is common practice in many fields of medicine, observational studies of its effect on the quality of care have shown mixed results. The objective of this study is to evaluate the effect of performance feedback on the quality of care for acute ischemic stroke.

Methods: PERFEQTOS is a stepped wedge cluster randomized trial in 13 hospitals in the Netherlands providing endovascular thrombectomy for ischemic stroke. The primary outcome is the hospital's door-to-groin time. The study starts with a 6-month period in which none of the hospitals receives the performance feedback intervention. Subsequently, every 6 months, three or four hospitals are randomized to cross over from the control to the intervention conditions, until all hospitals receive the feedback intervention. The feedback intervention consists of a dashboard with quarterly reports on patient characteristics, structure, process, and outcome indicators related to patients with ischemic stroke treated with endovascular thrombectomy. Hospitals can compare their present performance with their own performance in the past and with other hospitals. The performance feedback is provided to local quality improvement teams in each hospital, who define their own targets on specific indicators and develop performance improvement plans. The impact of the performance feedback and improvement plans will be evaluated by comparing the primary outcome before and after the intervention.

Discussion: This study will provide evidence on the effectiveness of performance feedback to healthcare providers. The results will be actively disseminated through peer-reviewed journals, conference presentations, and various stakeholder engagement activities.

Trial registration: Netherlands Trial Register NL9090 . Registered on December 3, 2020.

Keywords: Endovascular thrombectomy; Ischemic stroke; Performance feedback; Quality of care; Stepped wedge cluster randomized trial.

Publication types

Clinical Trial Protocol

MeSH terms

Brain Ischemia* / diagnosis
Brain Ischemia* / surgery
Feedback
Hospitals
Humans
Ischemic Stroke*
Quality Improvement
Randomized Controlled Trials as Topic
Stroke* / diagnosis
Stroke* / surgery
Thrombectomy / adverse effects