Svendsen Marie Louise, Ehlers Lars Holger, Andersen Grethe, Johnsen Søren Paaske
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, Denmark.
Med Care. 2009 May;47(5):575-82. doi: 10.1097/MLR.0b013e318195f852.
The relationship between quality of care and economic outcome measures, including length of stay (LOS), among patients with stroke remains to be clarified.
To determine whether quality of care is associated with LOS among patients with stroke.
In this population-based follow-up study, we included 2636 patients with stroke who had been admitted to dedicated stroke units in Aarhus County, Denmark, from 2003 to 2005. Quality of care was measured as fulfillment of 12 criteria: early admission to a stroke unit, early antiplatelet therapy, early anticoagulant therapy, early computed tomography/magnetic resonance imaging scan, early water swallowing test, early mobilization, early intermittent catheterization, early deep venous thromboembolism prophylaxis, early assessment by a physiotherapist and an occupational therapist, and early assessment of nutritional and constipation risk. Data were analyzed by linear regression clustered at the stroke units by multilevel modeling.
Median LOS was 13 days (25th and 75th percentiles: 7, 33). Meeting each quality of care criteria was associated with shorter LOS. Adjusted relative LOS ranged from 0.67 (95% confidence interval (CI): 0.61-0.73) to 0.87 (95% CI: 0.81-0.93). The association between meeting more quality of care criteria and LOS followed a dose-response effect, that is, patients who fulfilled between 75% and 100% of the quality of care criteria were hospitalized about one-half as long as patients who fulfilled between 0% and 24% of the criteria (adjusted relative LOS: 0.53, 95% CI: 0.48-0.59).
Higher quality of care during the early phase of stroke was associated with shorter LOS among patients with stroke.
卒中患者的医疗质量与包括住院时间（LOS）在内的经济结局指标之间的关系仍有待阐明。
确定卒中患者的医疗质量是否与住院时间相关。
在这项基于人群的随访研究中，我们纳入了2003年至2005年期间在丹麦奥胡斯郡专门的卒中单元住院的2636例卒中患者。医疗质量通过12项标准的达成情况来衡量：早期入住卒中单元、早期抗血小板治疗、早期抗凝治疗、早期计算机断层扫描/磁共振成像扫描、早期饮水试验、早期活动、早期间歇性导尿、早期深静脉血栓栓塞预防、早期由物理治疗师和职业治疗师进行评估，以及早期评估营养和便秘风险。数据通过多水平模型在卒中单元聚类的线性回归进行分析。
中位住院时间为13天（第25和第75百分位数：7天，33天）。达到每项医疗质量标准都与较短的住院时间相关。调整后的相对住院时间范围为0.67（95%置信区间（CI）：0.61 - 0.73）至0.87（95% CI：0.81 - 0.93）。达到更多医疗质量标准与住院时间之间的关联呈现剂量反应效应，即达到75%至100%医疗质量标准的患者住院时间约为达到0%至24%标准患者的一半（调整后的相对住院时间：0.53，95% CI：0.48 - 0.59）。
卒中早期更高质量的医疗与卒中患者较短的住院时间相关。
