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.
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 language | English |
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Pages (from-to) | 1065-1070 |
Number of pages | 6 |
Journal | Stroke |
Volume | 46 |
Issue number | 4 |
Early online date | 12 Feb 2015 |
DOIs | |
Publication status | Published - Apr 2015 |
Bibliographical note
AcknowledgementsWe 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
Keywords
- patient outcome assessment
- selection bias
- standards
- survival
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Mary MacLeod
- School of Medicine, Medical Sciences & Nutrition, Cardiometabolic Disease
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Cardiovascular and Diabetes Centre
- School of Medicine, Medical Sciences & Nutrition, Applied Medicine - Senior Clinical Lecturer
- School of Medicine, Medical Sciences & Nutrition, Institute of Medical Sciences
Person: Clinical Academic
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Melanie Turner
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Centre for Health Data Science
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Research Fellow
- School of Medicine, Medical Sciences & Nutrition, Grampian Data Safe Haven (DaSH)
- Institute of Applied Health Sciences
Person: Academic Related - Research