Validation of intracerebral hemorrhage-specific intensity of care quality metrics

Adnan I. Qureshi, Shahram Majidi, Saqib A. Chaudhry, Mushtaq H. Qureshi, M. Fareed K Suri

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14 Scopus citations


Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)661-667
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number5
StatePublished - Jul 2013

Bibliographical note

Funding Information:
Supported by National Institute of Neurological Diseases and Stroke grant 1U01NS062091-01A2 (to AIQ), American Heart Association Established Investigator Award 0840053N (Innovative Strategies for Treating Cerebral Hemorrhage) (to AIQ), and National Institutes of Health grant 1R01HL105626-01A1 (to MFKS).


  • Mortality
  • boot strap method
  • care components
  • cerebral hemorrhage
  • intensive care unit
  • quality indicator


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