Development and Validation of Care Pathway Quality Indicators for Stroke and Chronic Coronary Syndrome Using French Administrative Healthcare Database (DELIQUA-CNV)

As part of the reform of the French healthcare system, financing models will be adjusted to better account for the quality, safety, and relevance of care, promote coordination among healthcare providers, and establish standardized care pathways. To this end, quality indicators for care pathways are expected for ten priority chronic conditions, including Chronic Coronary Syndromes (CCS) and stroke. These indicators will play a central role in the evaluation of the new quality-based financing system, which focuses on patient care pathways. The DELIQUA-CNV project aims to develop and validate four quality indicators for CCS and stroke care pathways based on data from the French National Health Data System (SNDS).

Readmission following percutaneous coronary intervention (PCI) represents a significant source of healthcare costs and serves as a key indicator of care quality. While readmissions for planned PCI, often driven by activity-based costing models, raise concerns regarding their relevance, they also contribute to increased patient risks and higher healthcare expenses. On the other hand, emergency readmissions after an outpatient procedure serve as a crucial safety indicator for ambulatory care practices. As such, the two key indicators for the CCS care pathway are: 1) Readmission for a new scheduled PCI following an initial PCI for CCS (Sched Re-PCI), and 2) Readmission for a new emergency PCI or coronary angiography following an ambulatory PCI for CCS (Outp Emerg Re-PCI).

The post-stroke phase is crucial, as challenges in referring patients to appropriate rehabilitation facilities often results in gaps and disparities in access to care. These gaps disrupt the continuity of the care pathway. Multi-professional post-stroke consultations are essential for assessing consequences of the stroke and ensuring the delivery of appropriate care. Therefore, the selected indicators for the stroke care pathway are intended to strengthen the organization and quality of care during the post-acute phase: 3) Post-hospitalization orientation during the acute phase according to stroke severity (Stroke_Orient), 4) Identification of multidisciplinary post-stroke consultations between 2 and 6 months after the acute phase (Post-stroke_Cnslt).

To develop these indicators, three population-based cohorts for each care pathway will be derived from cardio-neurovascular registers in Nouvelle-Aquitaine region. The first cohort will be obtained from the interventional cardiology registry for (ACIRA) covering the period from 2017 to 2021. The second cohort will be based on the Aquitaine Observatory of Stroke - Acute phase module (OBA2) for the years 2019 to 2021. The third cohort will focus on post-stroke consultation between July 2022 and December 2023 extraced from OBA2 - Post consulation module. These cohorts will be linked to data from the SNDS, utilizing an indirect deterministic matching approach. These linked databases will serve as the primary reference for validating the quality indicators. These validated indicators will subsequently play a key role in refining care practices and advancing the implementation of quality-based financing models within the healthcare system.

Inclusion criteria

cohort Chronic Coronary Syndromes (CSS)

• Patient being over 18 years of age living in metropolitan France;
• Patients underwent coronary angiography or PCI between January 2017 and December 2021 for an indication of CCS (stable angina, silent ischemia, other ischemia) at one of the 11 interventional cardiology centers in Aquitaine;

Exclusion criteria

cohort Chronic Coronary Syndromes (CSS)

• Patients refused to participate in the ACIRA registry (The ACIRA registry is an on-going, multicenter, prospective, exhaustive cohort study of patients who undergo coronary angiography or PCI in eleven interventional cardiology centers in the french Aquitaine region);
• Patients who died during the index hospitalization
• Patients with ACIRA stays not matched with SNDS data

Inclusion criteria

acute phase stroke cohort:

• Patient being over 18 years of age living in metropolitan France;
• Patients treated between January 2019 and December 2021 for a recent stroke (less than 15 days) with clear onset (sudden onset, focal nature of the neurological deficit, confirmation by brain imaging - CT scan or MRI - showing a vascular origin, either ischemic or hemorrhagic, consistent with the clinical presentation) at one of the 16 healthcare facilities in Nouvelle-Aquitaine that treat more than 30 strokes per year.

Exclusion criteria

acute phase stroke cohort:

• Patients refused to participate in the Aquitaine Observatory of stroke of patients diagnosed with a confirmed ischemic or hemorrhagic stroke (OBA2 registry - Acute phase module)
• Patients treated for rehabilitation of sequelae or complications of a recent stroke (less than 15 days), transient ischemic attack (TIA), or any other neurological condition (meningeal hemorrhage, traumatic intracranial hemorrhage, brain tumor, etc.)
• Patients who died during the index hospitalization
• Patients transferred to another facility not participating in ObA2
• Patients with ObA2 stays not matched with SNDS data

Inclusion criteria

post-stroke consultation cohort:

• Patient being over 18 years of age living in metropolitan France;
• Patients who benefited from post-stroke consultation between July 2022 and December 2023 following a recent completed stroke (sudden onset, focal nature of the neurological deficit, confirmation by brain imaging - CT scan or MRI - showing a vascular origin, either ischemic or hemorrhagic, consistent with the clinical presentation) within one year after the acute episode,

Exclusion criteria

post-stroke consultation cohort:

• Patients refused to participate in the OBA2 registry registry (The Aquitaine Observatory of stroke of patients diagnosed with a confirmed ischemic or hemorrhagic stroke - Multidisciplinary post-stroke consultation) (OBA2 registry - Post-consulation module)
• Patients treated for rehabilitation of sequelae or complications of a recent stroke (less than 15 days), transient ischemic attack (TIA), or any other neurological condition (meningeal hemorrhage, traumatic intracranial hemorrhage, brain tumor, ...);