Cadilhac Dominique A, Andrew Nadine E, Lannin Natasha A, Middleton Sandy, Levi Christopher R, Dewey Helen M, Grabsch Brenda, Faux Steve, Hill Kelvin, Grimley Rohan, Wong Andrew, Sabet Arman, Butler Ernest, Bladin Christopher F, Bates Timothy R, Groot Patrick, Castley Helen, Donnan Geoffrey A, Anderson Craig S
From the Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., N.E.A.); Florey Institute Neuroscience and Mental Health, Heidelberg, University of Melbourne, Victoria, Australia (D.A.C., B.G., C.F.B., G.A.D.); College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.); Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia (N.A.L.); Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, New South Wales (S.M.); Priority Research Centre for Translational Neurosciences Mental Health Research, University of Newcastle and Hunter Research Institute, New South Wales, Australia (C.R.L.); Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia (H.M.D., C.F.B.); Faculty of Medicine, The University of New South Wales, Sydney and St Vincent's Hospital, Darlinghurst, Australia (S.F.); National Stroke Foundation, Melbourne, Victoria, Australia (K.H.); University of Queensland, Brisbane, Australia (R.G., A.W.); Neurology Department, Royal Brisbane and Women's Hospital, Queensland, Australia (A.W.); Neurology Department, Gold Coast Hospital, Queensland, Australia (A.S.); Neurology Department, Peninsula Health, Frankston, Victoria, Australia (E.B.); Swan District Hospital and University of Western Australia, Perth, Australia (T.R.B.); South West Healthcare, Warrnambool, Victoria, Australia (P.G.); Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia (H.C.); The George Institute for Global Health, The University of Sydney, New South Wales, Australia (C.S.A.); and Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (C.S.A.).
Stroke. 2017 Apr;48(4):1026-1032. doi: 10.1161/STROKEAHA.116.015714. Epub 2017 Mar 3.
Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke.
Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received.
There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%).
Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
质量改进策略是否能转化为更好的健康相关生活质量（HRQoL）以及急性卒中后的生存率，目前尚不确定。我们旨在确定卒中后最佳实践推荐干预措施与结局之间的关联。
数据来自2010年至2014年的澳大利亚卒中临床登记处。采用多变量回归分析来确定三种干预措施之间的关联：接受急性卒中单元（ASU）护理，并与出院时开具的抗高血压药物以各种组合形式使用、提供出院护理计划，以及按卒中类型在180天时的生存结局和HRQoL（欧洲五维健康量表视觉模拟量表）。还对与患者接受的流程数量相关的结局进行了评估。
评估了来自42家医院（77%为大都市医院）的17585例卒中入院患者（中位年龄77岁，47%为女性；81%在ASU接受治疗；80%为缺血性卒中）。与患者接受的护理流程数量相关的结局有累积益处。ASU护理与180天内死亡可能性降低（风险比，0.49；95%置信区间，0.43 - 0.56）以及更好的HRQoL（系数，21.34；95%置信区间，15.50 - 27.18）相关。对于出院患者，与仅接受ASU护理（风险比，0.64；95%置信区间，0.54 - 0.76）相比，接受ASU + 抗高血压药物治疗的患者180天生存率更高（风险比，0.45；95%置信区间，0.38 - 0.5）。接受涉及出院流程护理包的脑出血患者的HRQoL改善最大（改善幅度为11% - 19%）。
接受最佳实践推荐医院护理的卒中患者长期生存率和HRQoL得到改善。
