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, CENTER-TBI Investigators and Participants

Research output: Contribution to journalArticleResearchpeer-review

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 - 1 Aug 2016

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
Cnossen, Maryse C. ; Polinder, Suzanne ; Lingsma, Hester F. ; Maas, Andrew I. R. ; Menon, David ; Steyerberg, Ewout W. ; 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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doi = "10.1371/journal.pone.0161367",
language = "English",
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issn = "1932-6203",
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Cnossen, MC, Polinder, S, Lingsma, HF, Maas, AIR, Menon, D, Steyerberg, EW & 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

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.; CENTER-TBI Investigators and Participants.

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

Research output: Contribution to journalArticleResearchpeer-review

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 - Cnossen, Maryse C.

AU - Polinder, Suzanne

AU - Lingsma, Hester F.

AU - Maas, Andrew I. R.

AU - Menon, David

AU - Steyerberg, Ewout W.

AU - CENTER-TBI Investigators and Participants

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 - Bučková, Veronika

AU - Calappi, Emiliana

AU - Cameron, Peter

AU - Carbayo, Lozano Guillermo

AU - Carise, Elsa

AU - Carpenter, C.

AU - Castaño-León, Ana M.

AU - Causin, Francesco

AU - Chevallard, Giorgio

AU - Chieregato, Arturo

AU - Citerio, Giuseppe

AU - Coburn, Mark Coburn

AU - Coles, Jonathan

AU - Cooper, Jamie D.

AU - Correia, Marta

AU - Covic, Amra

AU - Curry, Nicola

AU - Czeiter, Endre

AU - Czosnyka, Marek

AU - Dahyot-Fizelier, Claire

AU - Damas, François

AU - Damas, Pierre

AU - Dawes, Helen

AU - De Keyser, Véronique

AU - Della Corte, Francesco

AU - Depreitere, Bart

AU - Ding, Shenghao

AU - Dippel, Diederik

AU - Dizdarevic, Kemal

AU - Dulière, Guy Loup

AU - Dzeko, Adelaida

AU - Eapen, George

AU - Engemann, Heiko

AU - Ercole, Ari

AU - Esser, Patrick

AU - Ezer, Erzsébet

AU - Fabricius, Martin

AU - Feigin, Valery L.

AU - Feng, Junfeng

AU - Foks, Kelly

AU - Fossi, Francesca

AU - Francony, Gilles

AU - Frantzén, Janek

AU - Freo, Ulderico

AU - Frisvold, Shirin

AU - Furmanov, Alex

AU - Gagliardo, Pablo

AU - Galanaud, Damien

AU - Gao, Guoyi

AU - Geleijns, Karin

AU - Ghuysen, Alexandre

AU - Giraud, Benoit

AU - Glocker, Ben

AU - Gomez, Pedro A.

AU - Grossi, Francesca

AU - Gruen, Russell L.

AU - Gupta, Deepak

AU - Haagsma, Juanita A.

AU - Hadzic, Ermin

AU - Haitsma, Iain

AU - Hartings, Jed A.

AU - Helbok, Raimund

AU - Helseth, Eirik

AU - Hertle, Daniel

AU - Hill, Sean

AU - Hoedemaekers, Astrid

AU - Hoefer, Stefan

AU - Hutchinson, Peter J.

AU - Håberg, Asta Kristine

AU - Jacobs, Bram

AU - Janciak, Ivan

AU - Janssens, Koen

AU - Jiang, Jiyao

AU - Jones, Kelly

AU - Kalala, Jean Pierre

AU - Kamnitsas, Konstantinos

AU - Karan, Mladen

AU - Karau, Jana

AU - Katila, Ari

AU - Kaukonen, Maija

AU - Keeling, David

AU - Kerforne, Thomas

AU - Ketharanathan, Naomi

AU - Kettunen, Johannes

AU - Kivisaari, Riku

AU - Kolias, Angelos G.

AU - Kolumbán, Bálint

AU - Kompanje, Erwin

AU - Kondziella, Daniel

AU - Koskinen, Lars Owe

AU - Kovács, Noémi

AU - Kálovits, Ferenc

AU - Lagares, Alfonso

AU - Lanyon, Linda

AU - Laureys, Steven

AU - Lauritzen, Martin

AU - Lecky, Fiona

AU - Ledig, Christian

AU - Lefering, Rolf

AU - Legrand, Valerie

AU - Lei, Jin

AU - Levi, Leon

AU - Lightfoot, Roger

AU - Lingsma, Hester

AU - Loeckx, Dirk

AU - Lozano, Angels

AU - Luddington, Roger

AU - Luijten-Arts, Chantal

AU - Maas, Andrew I R

AU - MacDonald, Stephen

AU - MacFayden, Charles

AU - Maegele, Marc

AU - Majdan, Marek

AU - Major, Sebastian

AU - Manara, Alex

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AU - Manley, Geoffrey

AU - Martin, Didier

AU - Martino, Costanza

AU - Maruenda, Armando

AU - Maréchal, Hugues

AU - Mastelova, Dagmara

AU - Mattern, Julia

AU - McMahon, Catherine

AU - Melegh, Béla

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AU - Morganti-Kossmann, Cristina

AU - Mulazzi, Davide

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AU - Noirhomme, Quentin

AU - Nyirádi, József

AU - Oddo, Mauro

AU - Oldenbeuving, Annemarie

AU - Oresic, Matej

AU - Ortolano, Fabrizio

AU - Palotie, Aarno

AU - Parizel, Paul M.

AU - Patruno, Adriana

AU - Payen, Jean François

AU - Perera, Natascha

AU - Perlbarg, Vincent

AU - Persona, Paolo

AU - Peul, Wilco

AU - Pichon, Nicolas

AU - Piilgaard, Henning

AU - Piippo, Anna

AU - Pili, Floury Sébastien

AU - Pirinen, Matti

AU - Ples, Horia

AU - Pomposo, Inigo

AU - Psota, Marek

AU - Pullens, Pim

AU - Puybasset, Louis

AU - Ragauskas, Arminas

AU - Raj, Rahul

AU - Rambadagalla, Malinka

AU - Rehorčíková, Veronika

AU - Rhodes, Jonathan

AU - Richardson, Sylvia

AU - Ripatti, Samuli

AU - Rocka, Saulius

AU - Rodier, Nicolas

AU - Roe, Cecilie

AU - Roise, Olav

AU - Roks, Gerwin

AU - Romegoux, Pauline

AU - Rosand, Jonathan

AU - Rosenfeld, Jeffrey

AU - Rosenlund, Christina

AU - Rosenthal, Guy

AU - Rossaint, Rolf

AU - Rossi, Sandra

AU - Rostalski, Tim

AU - Rueckert, Danie L.

AU - Ruiz De Arcaute, Felix

AU - Rusnák, Martin

AU - Sacchi, Marco

AU - Sahakian, Barbara

AU - Sahuquillo, Juan

AU - Sakowitz, Oliver

AU - Sala, Francesca

AU - Sanchez-Pena, Paola

AU - Sanchez-Porras, Renan

AU - Sandor, Janos

AU - Santos, Edgar

AU - Sasse, Nadine

AU - Sasu, Luminita

AU - Savo, Davide

AU - Schipper, Inger

AU - Schlößer, Barbara

AU - Schmidt, Silke

AU - Schneider, Annette

AU - Schoechl, Herbert

AU - Schoonman, Guus

AU - Schou, Rico Frederik

AU - Synnot, Anneliese

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.

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.

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U2 - 10.1371/journal.pone.0161367

DO - 10.1371/journal.pone.0161367

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VL - 11

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 8

M1 - e0161367

ER -