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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Authors | Melanie Turner, Mark Barber, Hazel Dodds, David Murphy, Martin Dennis, Peter Langhorne, Mary-Joan Macleod, Scottish Stroke Care Audit |
Journal | Stroke
(Stroke)
Vol. 46
Issue 4
Pg. 1065-70
(Apr 2015)
ISSN: 1524-4628 [Electronic] United States |
PMID | 25677597
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Copyright | © 2015 American Heart Association, Inc. |
Topics |
- Aged
- Aged, 80 and over
- Brain Ischemia
(epidemiology, mortality, therapy)
- Cohort Studies
- Humans
- Male
- Outcome Assessment, Health Care
(statistics & numerical data)
- Patient Care Bundles
(methods, standards, statistics & numerical data)
- Registries
(statistics & numerical data)
- Scotland
(epidemiology)
- Stroke
(epidemiology, mortality, therapy)
- Treatment Outcome
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