TY - JOUR
T1 - Variation in structure and process of care in traumatic brain injury
T2 - Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study
AU - CENTER-TBI investigators and participants
AU - Cnossen, Maryse C.
AU - Polinder, Suzanne
AU - Lingsma, Hester F.
AU - Maas, Andrew I.R.
AU - Menon, David
AU - Steyerberg, Ewout W.
AU - Adams, Hadie
AU - Alessandro, Masala
AU - Allanson, Judith
AU - Amrein, Krisztina
AU - Andaluz, Norberto
AU - Andelic, Nada
AU - Andrea, Nanni
AU - Andreassen, Lasse
AU - Anke, Audny
AU - Antoni, Anna
AU - Ardon, Hilko
AU - Audibert, Gérard
AU - Azouvi, Philippe
AU - Baciu, Camelia
AU - Bacon, Andrew
AU - Badenes, Rafael
AU - Baglin, Trevor
AU - Bartels, Ronald
AU - Barzó, Pál
AU - Bauerfeind, Ursula
AU - Beer, Ronny
AU - Belda, Francisco Javier
AU - Bellander, Bo Michael
AU - Belli, Antonio
AU - Bellier, Rémy
AU - Benali, Habib
AU - Benard, Thierry
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Beynon, Christopher
AU - Bilotta, Federico
AU - Binder, Harald
AU - Biqiri, Erta
AU - Blaabjerg, Morten
AU - Borgen, Lund Stine
AU - Bouzat, Pierre
AU - Bragge, Peter
AU - Brazinova, Alexandra
AU - Brehar, Felix
AU - Brorsson, Camilla
AU - Buki, Andras
AU - Bullinger, Monika
AU - Bučková, Veronika
A2 - Auslands, Kaspars
N1 - Funding Information:
Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission 7th Framework program (602150). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to thank all CENTER-TBI investigators and their staff, who are listed below, for completing the provider profiling questionnaires. Authors would further like to thank Nada Andelic, Sasha Brazinova, Ruben van der Brande, Peter Cameron, Guiseppe Citerio, Ari Ercole, Thomas van Essen, Mathieu van der Jagt, Erwin Kompanje, Fiona Lecky, Joukje van der Naalt, David Nelson, Wilco Peul, Jukka Ranta, Cecilia Roe, Gerard Ribbers, Nino Stochetti, Olli Tenovuo and Lindsay Wilson for their help with the development of the provider profiling questionnaires.
Publisher Copyright:
© 2016 Cnossen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2016/8
Y1 - 2016/8
N2 - Introduction: 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. Conclusion: 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.
AB - Introduction: 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. Conclusion: 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.
UR - http://www.scopus.com/inward/record.url?scp=84991063666&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0161367
DO - 10.1371/journal.pone.0161367
M3 - Article
C2 - 27571205
AN - SCOPUS:84991063666
SN - 1932-6203
VL - 11
JO - PLoS ONE
JF - PLoS ONE
IS - 8
M1 - e0161367
ER -