mplementing a simple care bundle is associated with improved outcomes in a national cohort of patients with ischemic stroke

Turner, M., Barber, M., Dodds, H., Murphy, D., Dennis, M., Langhorne, P. and Macleod, M.-J. (2015) mplementing a simple care bundle is associated with improved outcomes in a national cohort of patients with ischemic stroke. Stroke, 46(4), pp. 1065-1070. (doi: 10.1161/STROKEAHA.114.007608) (PMID:25677597)

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.<p></p> 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.<p></p> 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]).<p></p> 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.<p></p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Langhorne, Professor Peter
• Authors: Turner, M., Barber, M., Dodds, H., Murphy, D., Dennis, M., Langhorne, P., and Macleod, M.-J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628