Department of Medicine, University of Toronto, Toronto, Ontario.
CMAJ. 2013 Jul 9;185(10):E483-91. doi: 10.1503/cmaj.121418. Epub 2013 May 27.
Systems of stroke care delivery have been promoted as a means of improving the quality of stroke care, but little is known about their effectiveness. We assessed the effect of the Ontario Stroke System, a province-wide strategy of regionalized stroke care delivery, on stroke care and outcomes in Ontario, Canada.
We used population-based provincial administrative databases to identify all emergency department visits and hospital admissions for acute stroke and transient ischemic attack from Jan. 1, 2001, to Dec. 31, 2010. Using piecewise regression analyses, we assessed the effect of the full implementation of the Ontario Stroke System in 2005 on the proportion of patients who received care at stroke centres, and on rates of discharge to long-term care facilities and 30-day mortality after stroke.
We included 243 287 visits by patients with acute stroke or transient ischemic attack. The full implementation of the Ontario Stroke System in 2005 was associated with an increase in rates of care at stroke centres (before implementation: 40.0%; after implementation: 46.5%), decreased rates of discharge to long-term care facilities (before implementation: 16.9%; after implementation: 14.8%) and decreased 30-day mortality for hemorrhagic (before implementation: 38.3%; after implementation: 34.4%) and ischemic stroke (before implementation: 16.3%; after implementation: 15.7%). The system's implementation was also associated with marked increases in the proportion of patients who received neuroimaging, thrombolytic therapy, care in a stroke unit and antithrombotic therapy.
The implementation of an organized system of stroke care delivery was associated with improved processes of care and outcomes after stroke.
卒中护理系统的推行被视为改善卒中护理质量的手段，但对其效果知之甚少。我们评估了安大略卒中系统（一种全省范围的区域性卒中护理实施策略）对加拿大安大略省卒中护理和结局的影响。
我们使用基于人群的省级行政数据库，从 2001 年 1 月 1 日至 2010 年 12 月 31 日，确定所有因急性卒中和短暂性脑缺血发作而到急诊就诊和住院的患者。采用分段回归分析，评估 2005 年安大略卒中系统全面实施对患者接受卒中中心护理比例的影响，以及卒后入住长期护理机构的比例和 30 天死亡率的变化。
我们纳入了 243287 例因急性卒中和短暂性脑缺血发作就诊的患者。2005 年安大略卒中系统的全面实施与卒中中心护理比例的增加相关（实施前：40.0%；实施后：46.5%），入住长期护理机构的比例降低（实施前：16.9%；实施后：14.8%），出血性卒中（实施前：38.3%；实施后：34.4%）和缺血性卒中（实施前：16.3%；实施后：15.7%）30 天死亡率降低。该系统的实施还与接受神经影像学检查、溶栓治疗、卒中单元护理和抗血栓治疗的患者比例显著增加相关。
实施有组织的卒中护理系统与改善卒后护理过程和结局相关。
