Implementing a Simple Care Bundle Is Associated With Improved Outcomes in a National Cohort of Patients With Ischemic Stroke

Melanie Turner, Mark Barber, Hazel Dodds, David Murphy, Scottish Stroke Care Audit

Research output: Contribution to journalArticle

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Abstract

Background and Purpose—Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.
Methods—Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.
Results—A total of 36 055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95% confidence interval]: 0.82 [0.75–0.90], 0.88 [0.77–0.99], and 0.39 [0.35–0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95% confidence interval], 2.95 [1.91–4.55]) to 3 versus 4 (adjusted odds ratio [95% confidence interval], 1.21 [1.09–1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95% confidence interval], 0.91 [0.85–0.98]).
Conclusions—Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.
Original languageEnglish
Pages (from-to)1065-1070
Number of pages6
JournalStroke
Volume46
Issue number4
Early online date12 Feb 2015
DOIs
Publication statusPublished - Apr 2015

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Patient Care Bundles
Stroke
Odds Ratio
Confidence Intervals
Mortality
Deglutition
Aspirin
Scotland
Research
Population

Keywords

  • patient outcome assessment
  • selection bias
  • standards
  • survival

Cite this

Implementing a Simple Care Bundle Is Associated With Improved Outcomes in a National Cohort of Patients With Ischemic Stroke. / Turner, Melanie; Barber, Mark; Dodds, Hazel; Murphy, David ; Scottish Stroke Care Audit.

In: Stroke, Vol. 46, No. 4, 04.2015, p. 1065-1070.

Research output: Contribution to journalArticle

Turner, Melanie ; Barber, Mark ; Dodds, Hazel ; Murphy, David ; Scottish Stroke Care Audit. / Implementing a Simple Care Bundle Is Associated With Improved Outcomes in a National Cohort of Patients With Ischemic Stroke. In: Stroke. 2015 ; Vol. 46, No. 4. pp. 1065-1070.
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abstract = "Background and Purpose—Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.Methods—Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.Results—A total of 36 055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95{\%} confidence interval]: 0.82 [0.75–0.90], 0.88 [0.77–0.99], and 0.39 [0.35–0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95{\%} confidence interval], 2.95 [1.91–4.55]) to 3 versus 4 (adjusted odds ratio [95{\%} confidence interval], 1.21 [1.09–1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95{\%} confidence interval], 0.91 [0.85–0.98]).Conclusions—Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.",
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author = "Melanie Turner and Mark Barber and Hazel Dodds and David Murphy and Martin Dennis and Peter Langhorne and MacLeod, {Mary Joan} and {Scottish Stroke Care Audit}",
note = "Acknowledgements We acknowledge the support of all audit coordinators and clinicians who contribute to the Scottish Stroke Care Audit. Information Services Division, National Health Service Scotland (in particular Lindsey Waugh) supported data linkage with General Register Office",
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T1 - Implementing a Simple Care Bundle Is Associated With Improved Outcomes in a National Cohort of Patients With Ischemic Stroke

AU - Turner, Melanie

AU - Barber, Mark

AU - Dodds, Hazel

AU - Murphy, David

AU - Dennis, Martin

AU - Langhorne, Peter

AU - MacLeod, Mary Joan

AU - Scottish Stroke Care Audit

N1 - Acknowledgements We acknowledge the support of all audit coordinators and clinicians who contribute to the Scottish Stroke Care Audit. Information Services Division, National Health Service Scotland (in particular Lindsey Waugh) supported data linkage with General Register Office

PY - 2015/4

Y1 - 2015/4

N2 - Background and Purpose—Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.Methods—Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.Results—A total of 36 055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95% confidence interval]: 0.82 [0.75–0.90], 0.88 [0.77–0.99], and 0.39 [0.35–0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95% confidence interval], 2.95 [1.91–4.55]) to 3 versus 4 (adjusted odds ratio [95% confidence interval], 1.21 [1.09–1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95% confidence interval], 0.91 [0.85–0.98]).Conclusions—Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.

AB - Background and Purpose—Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.Methods—Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.Results—A total of 36 055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95% confidence interval]: 0.82 [0.75–0.90], 0.88 [0.77–0.99], and 0.39 [0.35–0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95% confidence interval], 2.95 [1.91–4.55]) to 3 versus 4 (adjusted odds ratio [95% confidence interval], 1.21 [1.09–1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95% confidence interval], 0.91 [0.85–0.98]).Conclusions—Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.

KW - patient outcome assessment

KW - selection bias

KW - standards

KW - survival

U2 - 10.1161/STROKEAHA.114.007608

DO - 10.1161/STROKEAHA.114.007608

M3 - Article

VL - 46

SP - 1065

EP - 1070

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 4

ER -