Quality of Acute Care and Long-Term Quality of Life and Survival: The Australian Stroke Clinical Registry

被引：62

作者：

Cadilhac, Dominique A. ^{[1
,2
]}

Andrew, Nadine E. ^{[1
]}

Lannin, Natasha A. ^{[3
,4
]}

Middleton, Sandy ^{[5
,6
]}

Levi, Christopher R. ^{[7
,8
]}

Dewey, Helen M. ^{[9
]}

Grabsch, Brenda ^{[2
]}

Faux, Steve ^{[10
,11
]}

Hill, Kelvin ^{[12
]}

Grimley, Rohan ^{[13
]}

Wong, Andrew ^{[13
,14
]}

Sabet, Arman ^{[15
]}

Butler, Ernest ^{[16
]}

Bladin, Christopher F. ^{[2
,9
]}

Bates, Timothy R. ^{[17
,18
]}

Groot, Patrick ^{[19
]}

Castley, Helen ^{[20
]}

Donnan, Geoffrey A. ^{[2
]}

Anderson, Craig S. ^{[21
,22
]}

机构：

[1] Monash Univ, Monash Hlth, Sch Clin Sci, Stroke & Ageing Res, Clayton, Vic, Australia

[2] Univ Melbourne, Florey Inst Neurosci & Mental Hlth, Heidelberg, Vic, Australia

[3] La Trobe Univ, Sch Allied Hlth, Coll Sci Hlth & Engn, Bundoora, Vic, Australia

[4] Alfred Hlth, Occupat Therapy Dept, Prahran, Vic, Australia

[5] St Vincents Hlth Australia Sydney, Nursing Res Inst, Sydney, NSW, Australia

[6] Australian Catholic Univ, Sydney, NSW 2059, Australia

[7] Univ Newcastle, Prior Res Ctr Translat Neurosci Mental Hlth Res, Callaghan, NSW 2308, Australia

[8] Hunter Res Inst, New Lambton Hts, NSW, Australia

[9] Monash Univ, Eastern Hlth Clin Sch, Box Hill, Vic, Australia

[10] Univ New South Wales, Fac Med, Sydney, NSW, Australia

[11] St Vincents Hosp, Darlinghurst, NSW, Australia

[12] Natl Stroke Fdn, Melbourne, Vic, Australia

[13] Univ Queensland, Brisbane, Qld, Australia

[14] Royal Brisbane & Womens Hosp, Dept Neurol, Herston, Qld, Australia

[15] Gold Coast Hosp, Dept Neurol, Southport, Qld, Australia

[16] Peninsula Hlth, Dept Neurol, Frankston, Vic, Australia

[17] Swan Dist Hosp, Perth, WA, Australia

[18] Univ Western Australia, Perth, WA, Australia

[19] South West Healthcare, Warrnambool, Vic, Australia

[20] Royal Hobart Hosp, Dept Neurol, Hobart, Tas, Australia

[21] Univ Sydney, George Inst Global Hlth, Sydney, NSW 2006, Australia

[22] Royal Prince Alfred Hosp, Dept Neurol, Sydney, NSW, Australia

来源：

STROKE | 2017年 / 48卷 / 04期

基金：

澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;

关键词：

hospitals; quality of health care; quality of life; stroke; survival; MORTALITY; OUTCOMES; PATIENT; UNITS; MULTICENTER; INDICATORS; SERVICES; COHORT; EQ-5D;

D O I：

10.1161/STROKEAHA.116.015714

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Methods-Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. Results-There were 17585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%). Conclusions-Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.

引用

页码：1026 / 1032

页数：7

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