Processes and outcomes of ischemic stroke care: The influence of hospital level of care
Journal
International Journal for Quality in Health Care
Journal Volume
27
Journal Issue
4
Pages
260-266
Date Issued
2015
Author(s)
Abstract
Objective: Processes of stroke care play an increasingly important role in comparing hospital performance. The relationship between processes of care and outcomes for stroke is unclear. Moreover, in terms of stroke care regionalization, little information is available with regard to the relationships among hospital level of care, processes and outcomes of stroke care. We used nationwide population-based data to examine the relationship between processes of care and mortality and the relationships among hospital level of care, processes and mortality for ischemic stroke. Design: Cross-sectional study. Setting: General acute care hospitals throughout Taiwan. Participants: A total of 31 274 ischemic stroke patients admitted in 2010 through Taiwan's National Health Insurance Research Database. Main Outcome Measures: Processes of care and 30-day mortality. Multilevel modelswere used after adjustment for patient and hospital characteristics to test the relationship between processes of care and 30-day mortality and the relationships among hospital level of care, processes and 30-day mortality. Results: The use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessmentwas associated with lower mortality. Hospital level of carewas associated with the use of thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment, and mortality. These processes of care were mediators of the relationship between hospital level of care and mortality. Conclusions: Outcomes among patients with ischemic stroke can be improved by thrombolytic therapy, antithrombotic therapy, statin treatment and rehabilitation assessment. Among patients with ischemic stroke, admission to designated stroke center hospitals may be associated with lower mortality through better processes of care. ? The Author 2015.
SDGs
Other Subjects
anticoagulant agent; fibrinolytic agent; hydroxymethylglutaryl coenzyme A reductase inhibitor; tissue plasminogen activator; aged; Article; brain ischemia; brain surgery; cause of death; controlled study; cross-sectional study; female; fibrinolytic therapy; hospital admission; hospital care; human; major clinical study; male; mortality; population research; priority journal; rehabilitation care; Taiwan; treatment outcome; brain ischemia; epidemiology; hospital; hospitalization; mortality; standards; statistics and numerical data; Stroke; Aged; Brain Ischemia; Cross-Sectional Studies; Female; Hospitalization; Hospitals; Humans; Male; Outcome and Process Assessment (Health Care); Stroke; Taiwan
Publisher
Oxford University Press
Type
journal article