Quality of Care and Patient Outcome in Stroke Units

Is Medical Specialty of Importance

Bibliographic Data

ID9100041
AuthorsMarie Louise Svendsen (0000-0003-2291-0200, Aarhus University Hospital, corresponding author), Lars Holger Ehlers (0000-0001-6512-5566, Aalborg University), Mark Frydenberg (0000-0001-9652-341X, Aarhus University), Morten Frydenberg, Annette Ingeman (Aarhus University Hospital, corresponding author), Søren Paaske Johnsen (0000-0002-2787-0271, Aarhus University Hospital, corresponding author)
Year2011
Volume49
Issue8
Pages693-700
Publication date2011-08-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e318213c024
PMID21758024
OpenAlexW1790097562
LanguageEN
References cited27

BACKGROUND: Specialized stroke unit care improves outcome in stroke patients. However, it is uncertain whether the units should be placed in a neurological or non-neurological (eg, internal medicine or geriatric) setting. OBJECTIVES: To assess whether stroke unit setting (neurological/non-neurological) is associated with quality of care and outcome among patients with stroke, and whether these associations depend on the severity of comorbidity. METHODS: In a nationwide population-based follow-up study, we identified 45,521 patients admitted to stroke units in Denmark between 2003 and 2008. Outcomes were quality of care (whether patients received evidence-based processes of acute stroke care), mortality, length of stay, and readmission. Charlson comorbidity index was used to assess comorbidity, and comparisons were adjusted for patient and hospital characteristics. RESULTS: Patients admitted to stroke units in neurological settings had higher odds for early antiplatelet therapy (odds ratio, 1.68; 95% confidence interval, 1.10-2.56) and early computed tomographic scan or magnetic resonance imaging (odds ratio, 1.77; 95% confidence interval, 1.29-2.45) compared with patients in non-neurological settings. No other differences were found when studying quality of care and patient outcomes. However, patients with moderate comorbidity admitted to stroke units in neurological settings had higher odds for 1-year mortality, but comparisons across strata of comorbidity were not statistical significant. CONCLUSIONS: Except for early antiplatelet therapy and early computed tomographic scan or magnetic resonance imaging, the medical setting was not associated with differences in processes of acute stroke care and patient outcome. No medical setting related differences were found according to comorbidity, although indications of a worse outcome in patients with moderate comorbidity in neurological settings warrant further investigation

MEDLINE · Outcome (game theory) · Quality (philosophy) · Stroke (engine) · Acute Ischemic Stroke Management · Emergency Medicine · Intracerebral and Subarachnoid Hemorrhage Research · Medicine · Stroke Rehabilitation and Recovery

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