1 Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia.
2 Stroke Division, The Florey Institute of Neuroscience and Mental Health, Clayton, VIC, Australia.
Int J Stroke. 2018 Aug;13(6):585-591. doi: 10.1177/1747493017741382. Epub 2017 Nov 14.
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.
背景 卒中协调员在不同国家支持医院卒中治疗的应用并不一致。目的 研究卒中协调员与急性卒中单元医院提供基于证据的护理和患者结局之间的关系。
方法 采用 2015 年国家急性服务审计计划（澳大利亚）的横断面数据进行观察性研究：包括回顾性病历审核（每个医院 40 份记录）和卒中组织资源的自我报告调查。使用多水平随机效应逻辑回归分析患者结局，包括并发症、出院时的独立性和死亡。使用中位数回归进行住院时间比较。
结果 共有 109 家医院提交了 4060 例病例；其中 59 家（54%）有卒中协调员。与无卒中协调员的卒中单元医院（ N = 33，1333 例）的患者相比，有卒中协调员的卒中单元医院（ N = 53，2072 例）的患者更有可能在初始评估后 48 小时内接受临床实践，包括康复治疗（88%比 82%， p < 0.001）、危险因素修正建议（62%比 55%， p = 0.003）和获得出院护理计划（65%比 48%， p < 0.001）。并发症、出院时的独立性或死亡率无差异。有卒中协调员的患者更有可能接受住院康复治疗（调整后的优势比 1.8，95%置信区间 1.1-2.8），如果出院，急性住院时间缩短（中位数 14 小时， p = 0.03）。
结论 卒中协调员的存在与卒中单元医院的住院时间缩短和基于证据的护理改善相关。
