Abstract
Background: Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim: To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods: Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results: A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator (N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator (N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion: Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
| Original language | English |
|---|---|
| Pages (from-to) | 585-591 |
| Number of pages | 7 |
| Journal | International Journal of Stroke |
| Volume | 13 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Aug 2018 |
Keywords
- coordinator
- health policy
- health services research
- outcomes
- quality improvement
- Stroke
Cite this
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Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes : An observational study. / Purvis, Tara; Kilkenny, Monique F; Middleton, Sandy; Cadilhac, Dominique A.
In: International Journal of Stroke, Vol. 13, No. 6, 01.08.2018, p. 585-591.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes
T2 - An observational study
AU - Purvis, Tara
AU - Kilkenny, Monique F
AU - Middleton, Sandy
AU - Cadilhac, Dominique A
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim: To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods: Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results: A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator (N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator (N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion: Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
AB - Background: Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital. Aim: To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units. Methods: Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons. Results: A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator (N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator (N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03). Conclusion: Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.
KW - coordinator
KW - health policy
KW - health services research
KW - outcomes
KW - quality improvement
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=85041926156&partnerID=8YFLogxK
U2 - 10.1177/1747493017741382
DO - 10.1177/1747493017741382
M3 - Article
VL - 13
SP - 585
EP - 591
JO - International Journal of Stroke
JF - International Journal of Stroke
SN - 1747-4930
IS - 6
ER -