Variation in structure and process of care in traumatic brain injury

Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study

Maryse C. Cnossen, Suzanne Polinder, Hester F. Lingsma, Andrew I R Maas, David Menon, Ewout W. Steyerberg, Hadie Adams, Masala Alessandro, Judith Allanson, Krisztina Amrein, Norberto Andaluz, Nada Andelic, Nanni Andrea, Lasse Andreassen, Audny Anke, Anna Antoni, Hilko Ardon, Gérard Audibert, Kaspars Auslands, Philippe Azouvi & 31 others Camelia Baciu, Andrew Bacon, Rafael Badenes, Trevor Baglin, Ronald Bartels, Pál Barzó, Ursula Bauerfeind, Ronny Beer, Francisco Javier Belda, Bo Michael Bellander, Antonio Belli, Rémy Bellier, Habib Benali, Thierry Benard, Maurizio Berardino, Luigi Beretta, Christopher Beynon, Federico Bilotta, Harald Binder, Erta Biqiri, Morten Blaabjerg, Lund Stine Borgen, Pierre Bouzat, Peter Bragge, Alexandra Brazinova, Felix Brehar, Camilla Brorsson, Andras Buki, Monika Bullinger, Nino Stocchetti, CENTER-TBI Investigators and Participants

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere0161367
JournalPLoS One
Volume11
Issue number8
DOIs
Publication statusPublished - Aug 1 2016

Fingerprint

Brain
brain
Comparative Effectiveness Research
Intensive care units
Research
questionnaires
Intensive Care Units
Hospital Units
rehabilitation (people)
Trauma Centers
expert opinion
Intracranial Pressure
Expert Testimony
Traumatic Brain Injury
Practice Guidelines
Patient rehabilitation
Rehabilitation
Availability
Organizations
Surveys and Questionnaires

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Cnossen, M. C., Polinder, S., Lingsma, H. F., Maas, A. I. R., Menon, D., Steyerberg, E. W., ... CENTER-TBI Investigators and Participants (2016). Variation in structure and process of care in traumatic brain injury: Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study. PLoS One, 11(8), [e0161367]. https://doi.org/10.1371/journal.pone.0161367

Variation in structure and process of care in traumatic brain injury : Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study. / Cnossen, Maryse C.; Polinder, Suzanne; Lingsma, Hester F.; Maas, Andrew I R; Menon, David; Steyerberg, Ewout W.; Adams, Hadie; Alessandro, Masala; Allanson, Judith; Amrein, Krisztina; Andaluz, Norberto; Andelic, Nada; Andrea, Nanni; Andreassen, Lasse; Anke, Audny; Antoni, Anna; Ardon, Hilko; Audibert, Gérard; Auslands, Kaspars; Azouvi, Philippe; Baciu, Camelia; Bacon, Andrew; Badenes, Rafael; Baglin, Trevor; Bartels, Ronald; Barzó, Pál; Bauerfeind, Ursula; Beer, Ronny; Belda, Francisco Javier; Bellander, Bo Michael; Belli, Antonio; Bellier, Rémy; Benali, Habib; Benard, Thierry; Berardino, Maurizio; Beretta, Luigi; Beynon, Christopher; Bilotta, Federico; Binder, Harald; Biqiri, Erta; Blaabjerg, Morten; Borgen, Lund Stine; Bouzat, Pierre; Bragge, Peter; Brazinova, Alexandra; Brehar, Felix; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Stocchetti, Nino; CENTER-TBI Investigators and Participants.

In: PLoS One, Vol. 11, No. 8, e0161367, 01.08.2016.

Research output: Contribution to journalArticle

Cnossen, MC, Polinder, S, Lingsma, HF, Maas, AIR, Menon, D, Steyerberg, EW, Adams, H, Alessandro, M, Allanson, J, Amrein, K, Andaluz, N, Andelic, N, Andrea, N, Andreassen, L, Anke, A, Antoni, A, Ardon, H, Audibert, G, Auslands, K, Azouvi, P, Baciu, C, Bacon, A, Badenes, R, Baglin, T, Bartels, R, Barzó, P, Bauerfeind, U, Beer, R, Belda, FJ, Bellander, BM, Belli, A, Bellier, R, Benali, H, Benard, T, Berardino, M, Beretta, L, Beynon, C, Bilotta, F, Binder, H, Biqiri, E, Blaabjerg, M, Borgen, LS, Bouzat, P, Bragge, P, Brazinova, A, Brehar, F, Brorsson, C, Buki, A, Bullinger, M, Stocchetti, N & CENTER-TBI Investigators and Participants 2016, 'Variation in structure and process of care in traumatic brain injury: Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study', PLoS One, vol. 11, no. 8, e0161367. https://doi.org/10.1371/journal.pone.0161367
Cnossen, Maryse C. ; Polinder, Suzanne ; Lingsma, Hester F. ; Maas, Andrew I R ; Menon, David ; Steyerberg, Ewout W. ; Adams, Hadie ; Alessandro, Masala ; Allanson, Judith ; Amrein, Krisztina ; Andaluz, Norberto ; Andelic, Nada ; Andrea, Nanni ; Andreassen, Lasse ; Anke, Audny ; Antoni, Anna ; Ardon, Hilko ; Audibert, Gérard ; Auslands, Kaspars ; Azouvi, Philippe ; Baciu, Camelia ; Bacon, Andrew ; Badenes, Rafael ; Baglin, Trevor ; Bartels, Ronald ; Barzó, Pál ; Bauerfeind, Ursula ; Beer, Ronny ; Belda, Francisco Javier ; Bellander, Bo Michael ; Belli, Antonio ; Bellier, Rémy ; Benali, Habib ; Benard, Thierry ; Berardino, Maurizio ; Beretta, Luigi ; Beynon, Christopher ; Bilotta, Federico ; Binder, Harald ; Biqiri, Erta ; Blaabjerg, Morten ; Borgen, Lund Stine ; Bouzat, Pierre ; Bragge, Peter ; Brazinova, Alexandra ; Brehar, Felix ; Brorsson, Camilla ; Buki, Andras ; Bullinger, Monika ; Stocchetti, Nino ; CENTER-TBI Investigators and Participants. / Variation in structure and process of care in traumatic brain injury : Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study. In: PLoS One. 2016 ; Vol. 11, No. 8.
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abstract = "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.",
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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 - 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 - Auslands, Kaspars

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 - Stocchetti, Nino

AU - CENTER-TBI Investigators and Participants

PY - 2016/8/1

Y1 - 2016/8/1

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.

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