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 |
Keywords
- patient outcome assessment
- selection bias
- standards
- survival
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Profiles
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Mary MacLeod
- School of Medicine, Medical Sciences & Nutrition, Centre for Health Data Science
- Clinical Medicine
- School of Medicine, Medical Sciences & Nutrition, Applied Medicine - Senior Clinical Lecturer
- Institute of Medical Sciences
Person: Clinical Academic
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Melanie Turner
- School of Medicine, Medical Sciences & Nutrition, Centre for Health Data Science
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Research Fellow
- Clinical Medicine
- Institute of Applied Health Sciences
Person: Academic Related - Research