Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes

An observational study

Research output: Contribution to journalArticleResearchpeer-review

2 Citations (Scopus)

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 languageEnglish
Pages (from-to)585-591
Number of pages7
JournalInternational Journal of Stroke
Volume13
Issue number6
DOIs
Publication statusPublished - 1 Aug 2018

Keywords

  • coordinator
  • health policy
  • health services research
  • outcomes
  • quality improvement
  • Stroke

Cite this

@article{f8f4aa4ac1a147f08b106fe231470172,
title = "Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study",
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.",
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author = "Tara Purvis and Kilkenny, {Monique F} and Sandy Middleton and Cadilhac, {Dominique A}",
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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 journalArticleResearchpeer-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

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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 -