Improved in-hospital outcomes and care for patients in stroke research: An observational study

Objective: To describe stroke research activity in Australian acute public hospitals and determine if participation in research provides better quality of care and outcomes for patients with stroke. Methods: This was an observational study using data from hospitals that participated in the National Stroke Foundation (Australia) acute services audit program in 2009, 2011, and 2013. This included self-reported organizational features and a retrospective clinical audit of up to 40 medical records of patients with stroke from each hospital. Multilevel random effects logistic regression with level defined as hospital and adjustments for hospital, demographic, clinical, and stroke severity factors were undertaken. Results: A total of 240 hospitals submitted organizational data. Hospitals with a stroke unit (70% vs 7%, p < 0.001) and >200 stroke admissions per year (80% vs 17%, p < 0.001) reported greater involvement in research studies. Of 9,537 patients audited at 129 hospitals, 469 (5%) consented to participate in research. Patients who participated in research compared to nonparticipants were likely to be younger (median age 73 years; 25th percentile [Q1]: 63, 75th percentile [Q3]: 80, vs median age 76 years Q1: 64, Q3: 83; p < 0.001) and receive important clinical practices such as a swallow screen/assessment prior to oral intake (62% vs 56%; p < 0.01). An independent association with reduced in-hospital mortality (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.76) was evident if participating in research regardless of access to stroke unit care. Conclusions: Patients who participate in stroke research receive better in-hospital care and are more likely to survive compared to nonresearch participants. Classification of evidence: This study provides Class III evidence that patients with stroke who participate in research receive better quality of care and have reduced in-hospital mortality.