Martins Sheila Cristina Ouriques, Borelli Wyllians Vendramini, Secchi Thais Leite, Mantovani Gabriel Paulo, Pille Arthur, Mora Cuervo Daissy Liliana, Carbonera Leonardo Augusto, de Souza Ana Claudia, Martins Magda Carla Ouriques, Brondani Rosane, de Almeida Andrea Garcia, Dal Pizzol Angélica, Dos Santos Franciele Pereira, Alves Ana Claudia, Meier Nathalia Soares, Andrade Guilherme Pamplona Bueno, Maciel Pedro Angst, Weber Alexandre, Machado Gustavo Dariva, Parrini Mohamed, Nasi Luiz Antonio
Hospital Moinhos de Vento, Neurology Service and Postgraduate in Stroke Neurology, Porto Alegre, Brazil.
Hospital de Clínicas de Porto Alegre, Neurology Service, Porto Alegre, Brazil.
Front Neurol. 2022 May 6;13:857094. doi: 10.3389/fneur.2022.857094. eCollection 2022.
Acute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil.
PROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units.
When compared with the private setting ( = 165), patients from the public hospital ( = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability.
Patients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.
急性中风干预措施，如中风单元和再灌注治疗，有可能改善预后。然而，患者特征以及获得最佳中风护理方面存在许多差异。因此，我们旨在比较巴西两个代表公立和私立医疗系统的中风中心中风后的患者报告结局指标（PROMs）。
通过国际健康结局测量联盟（ICHOM）的PROMs在中风后90天进行评估，以比较巴西南部的两家巴西医院：一所公立大学医院和一家私立中风中心，两者均有中风治疗方案和中风单元。
与私立医院（n = 165）相比，公立医院（n = 175）的患者更年轻，危险因素控制较差，既往中风更频繁，且中风发作时病情更严重。两家医院静脉溶栓治疗的比例相似。只有5名患者接受了机械取栓术（MT），均在私立医院。公立医院患者在3个月时的结局明显更差，包括生活质量更差和功能依赖（60%对48%，P = 0.03）。以改良Rankin量表（mRS）评分衡量的不良结局与年龄较大、美国国立卫生研究院卒中量表（NIHSS）评分较高以及心力衰竭的存在显著相关。然而，公立医疗实践是任何自我报告残疾的有力预测因素。
在使用与私立医院相同方案的优质公立中风中心接受治疗的患者，以mRS和患者报告结局指标衡量，残疾情况更差，在沟通、穿衣、如厕、进食和行走方面的能力更弱。
