Case-Mix versus Workflows: A Knowledge Transfer Challenge

Hospitals can improve acute ischaemic stroke (AIS) management by implementing tried and tested methods employed at other hospitals. This knowledge transfer can address performance benchmarking differences between hospitals and countries to improve patient outcomes. The challenge is tailoring interventions to unique population characteristics.

MDR in AIS is trying to overcome this challenge by collecting patient and management variables to better understand how workflows and populations vary between centres. On the one hand, reducing door-to-reperfusion (DTR) time in AIS has been shown to improve patient outcomes. Therefore, workflow improvements that reduce DTR time should in theory translate into improved patient outcomes. However, benchmarking comparisons between hospitals can be caused by differences in patient populations, rather than different workflows. This poses a particular challenge when investing in novel technologies such as telemedicine solutions since their benefits may translate differently between sites. 

We are collecting a rich set of variables to overcome these challenges which will help us understand how to create personalised workflow interventions for hospitals. We are navigating the two worlds of case-mix and workflow differences between hospitals, summarised in the two sources below. Overcoming this will enable hospitals to better select high-yielding interventions for their patients.

Author: Richard Mospan, Lausanne University Hospital

References:

Amini, M.; Meijerink, M. R.; Boers, A. M.; Berkhemer, O. A.; van der Lugt, A.; Dippel, D. W. J.; Investigators, MRCLEAN (2020): Improving quality of stroke care through benchmarking center performance: why focusing on outcomes is not enough. BMC Health Services Research, Available at: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05841-y accessed on 27.02.2025.

Wolff, L.; et al. (2022): Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry. Stroke, Available at: https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.038557 accessed on 27.02.2025.

Keywords:

#KnowledgeTransfer #Benchmarking #FeatureSelection