Quality of Care and Mortality Among Patients With Stroke

A Nationwide Follow-up Study

Bibliographic Data

ID9105081
AuthorsAnnette Ingeman (corresponding author), Lars H Pedersen (0000-0001-6726-1991, Aarhus University Hospital), Lars Pedersen (0000-0002-9341-3888), Heidi H Hundborg (Aarhus University Hospital), Palle Petersen (Copenhagen University Hospital), Susanne Zielke (Bispebjerg Hospital), Jan Mainz (0000-0003-0242-9233), Paul Bartels (0000-0002-4423-3231, corresponding author), Søren Paaske Johnsen (0000-0002-2787-0271, Aarhus University Hospital)
Year2008
Volume46
Issue1
Pages63-69
Publication date2008-01-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181484b91
PMID18162857
OpenAlexW2057453223
LanguageEN
Citations received5
References cited25

BACKGROUND: The relationship between process and outcome measures among patients with stroke is unclear. OBJECTIVES: To examine the association between quality of care and mortality among patients with stroke in a nationwide population-based follow-up study. METHODS: Using data from The Danish National Indicator Project, a quality improvement initiative with participation of all Danish hospital departments caring for patients with stroke, we identified 29,573 patients hospitalized with stroke between January 13, 2003 and October 31, 2005. Quality of care was measured in terms of 7 specific criteria: early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early examination with computed tomography/magnetic resonance imaging scan, and early assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Data on 30- and 90-day mortality rates were obtained through the Danish Civil Registration System. RESULTS: Six of 7 of these criteria were associated with lower 30- and 90-day mortality rates. Adjusted mortality rate ratios corrected for clustering by department ranged from 0.41 to 0.83. We found indication of an inverse dose-response relationship between the number of quality of care criteria met and mortality; the lowest mortality rate was found among patients whose care met all criteria compared with patients whose care failed to meet any criteria (ie, adjusted 30-day mortality rate ratios: 0.45, 95% confidence interval: 0.24-0.66). When analyses were stratified by age and sex, the dose-response relationship was found in all subgroups. CONCLUSIONS: Higher quality of care during the early phase of stroke was associated with substantially lower mortality rates

Confidence interval · Danish · Environmental health · Mortality rate · Population · Stroke (engine) · Acute Ischemic Stroke Management · Emergency Medicine · Frailty in Older Adults · Internal Medicine · Medicine · Stroke Rehabilitation and Recovery