Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

Michelle Tornes (Corresponding Author), David J. McLernon, Max O. Bachmann, Stanley D. Musgrave, Elizabeth A. Warburton, John F. Potter, Phyo Kyaw Myint, On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

Research output: Contribution to journalArticle

Abstract

Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.

Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.


Results: We included 2241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3% to 11%. The hospital that had the lowest odds of UTI (odds ratio (OR)=0.50 (95% confidence interval (CI) 0.22 to 1.11)) in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate (OR=2.69 (1.56 to 4.64)) was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.

Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to address to improve the ultimate stroke outcome.
Original languageEnglish
Article number827
JournalFrontiers in Neurology
Volume10
DOIs
Publication statusPublished - 6 Aug 2019

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Urinary Tract Infections
Inpatients
Stroke
Logistic Models
Odds Ratio
Diagnosis-Related Groups
National Health Programs
Stroke Volume
Cohort Studies
Confidence Intervals

Keywords

  • stroke
  • health services resaerch
  • acute hospital
  • outcome
  • urinary tract infection (UTI)
  • MEDICAL COMPLICATIONS
  • MORTALITY
  • CHOLESTEROL
  • PNEUMONIA
  • health services research
  • IMPACT
  • PREDICTORS
  • acute hospitals
  • urinary tract infections
  • ACUTE ISCHEMIC-STROKE
  • COHORT
  • OUTCOMES
  • STAY
  • Acute hospitals
  • Stroke
  • Health services research
  • Outcome
  • Urinary tract infections

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Tornes, M., McLernon, D. J., Bachmann, M. O., Musgrave, S. D., Warburton, E. A., Potter, J. F., ... On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group (2019). Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. Frontiers in Neurology, 10, [827]. https://doi.org/10.3389/fneur.2019.00827

Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. / Tornes, Michelle (Corresponding Author); McLernon, David J.; Bachmann, Max O.; Musgrave, Stanley D.; Warburton, Elizabeth A.; Potter, John F.; Myint, Phyo Kyaw; On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group.

In: Frontiers in Neurology, Vol. 10, 827, 06.08.2019.

Research output: Contribution to journalArticle

Tornes, M, McLernon, DJ, Bachmann, MO, Musgrave, SD, Warburton, EA, Potter, JF, Myint, PK & On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group 2019, 'Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke', Frontiers in Neurology, vol. 10, 827. https://doi.org/10.3389/fneur.2019.00827
Tornes, Michelle ; McLernon, David J. ; Bachmann, Max O. ; Musgrave, Stanley D. ; Warburton, Elizabeth A. ; Potter, John F. ; Myint, Phyo Kyaw ; On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group. / Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke. In: Frontiers in Neurology. 2019 ; Vol. 10.
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abstract = "Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.Results: We included 2241 stroke admissions in our analysis; 171 (7.6{\%}) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3{\%} to 11{\%}. The hospital that had the lowest odds of UTI (odds ratio (OR)=0.50 (95{\%} confidence interval (CI) 0.22 to 1.11)) in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate (OR=2.69 (1.56 to 4.64)) was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to address to improve the ultimate stroke outcome.",
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author = "Michelle Tornes and McLernon, {David J.} and Bachmann, {Max O.} and Musgrave, {Stanley D.} and Warburton, {Elizabeth A.} and Potter, {John F.} and Myint, {Phyo Kyaw} and {On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group}",
note = "Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge. Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.",
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T1 - Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

AU - Tornes, Michelle

AU - McLernon, David J.

AU - Bachmann, Max O.

AU - Musgrave, Stanley D.

AU - Warburton, Elizabeth A.

AU - Potter, John F.

AU - Myint, Phyo Kyaw

AU - On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

N1 - Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge. Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

PY - 2019/8/6

Y1 - 2019/8/6

N2 - Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.Results: We included 2241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3% to 11%. The hospital that had the lowest odds of UTI (odds ratio (OR)=0.50 (95% confidence interval (CI) 0.22 to 1.11)) in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate (OR=2.69 (1.56 to 4.64)) was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to address to improve the ultimate stroke outcome.

AB - Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.Results: We included 2241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3% to 11%. The hospital that had the lowest odds of UTI (odds ratio (OR)=0.50 (95% confidence interval (CI) 0.22 to 1.11)) in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate (OR=2.69 (1.56 to 4.64)) was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to address to improve the ultimate stroke outcome.

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KW - health services resaerch

KW - acute hospital

KW - outcome

KW - urinary tract infection (UTI)

KW - MEDICAL COMPLICATIONS

KW - MORTALITY

KW - CHOLESTEROL

KW - PNEUMONIA

KW - health services research

KW - IMPACT

KW - PREDICTORS

KW - acute hospitals

KW - urinary tract infections

KW - ACUTE ISCHEMIC-STROKE

KW - COHORT

KW - OUTCOMES

KW - STAY

KW - Acute hospitals

KW - Stroke

KW - Health services research

KW - Outcome

KW - Urinary tract infections

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U2 - 10.3389/fneur.2019.00827

DO - 10.3389/fneur.2019.00827

M3 - Article

VL - 10

JO - Frontiers in Neurology

JF - Frontiers in Neurology

SN - 1664-2295

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