Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Eur Stroke J. 2024 Dec;9(4):1000-1007. doi: 10.1177/23969873241249580. Epub 2024 May 5.
High quality of early stroke care is essential for optimizing the chance of a good patient outcome. The quality of care may be monitored by process performance measures (PPMs) and previous studies have found an association between fulfilment of PPMs and short-term mortality. However, the association with long-term mortality remains to be determined. We aimed to evaluate the association between fulfilment of PPMs and long-term mortality for patients with acute stroke in Denmark.
We used data from Danish health care registers between 2008 and 2020 to identify all patients admitted with incident stroke (haemorrhagic (ICH) or ischaemic stroke). The quality of early stroke care was assessed using 10 PPMs. Mortality was compared using Cox proportional hazard ratios, risk ratios computed using Poisson regression, and standardized relative survival.
We included 102,742 patients; 9804 cases of ICH, 88,591 cases of ischaemic stroke, and 4347 cases of unspecified strokes. The cumulative 10-year mortality risk was 56.8%. Fulfilment of the individual PPMs was associated with adjusted hazard rate ratios of death between 0.76 and 0.96. Patients with 100% fulfilment of all PPMs had a lower 10-year post-stroke mortality (adjusted risk ratio 0.90) compared to the patients with 0%-49% fulfilment and a standardized relative survival of 81.3%, compared to the general population.
High quality of early stroke care was associated with lower long-term mortality following both ICH and ischaemic stroke, which emphasizes the importance of continued attention on the ability of stroke care providers to deliver high quality of early care.
高质量的早期卒中护理对于优化患者的良好预后至关重要。护理质量可以通过过程绩效指标（PPM）进行监测，既往研究发现 PPM 的达标情况与短期死亡率之间存在关联。然而，与长期死亡率的关联仍有待确定。我们旨在评估丹麦急性卒中患者 PPM 达标情况与长期死亡率之间的关系。
我们使用丹麦医疗保健登记处 2008 年至 2020 年的数据，确定所有因急性卒中（出血性（ICH）或缺血性卒中）入院的患者。使用 10 个 PPM 评估早期卒中护理质量。使用 Cox 比例风险比、泊松回归计算的风险比和标准化相对生存率比较死亡率。
我们纳入了 102742 例患者；ICH 9804 例，缺血性卒中 88591 例，未明确类型卒中 4347 例。累积 10 年死亡率风险为 56.8%。个别 PPM 的达标情况与死亡的调整后危险率比相关，死亡风险比在 0.76 至 0.96 之间。与 0%-49% PPM 达标患者相比，100% PPM 达标的患者 10 年后卒中死亡率较低（调整后的风险比为 0.90），标准化相对生存率为 81.3%，与普通人群相比。
高质量的早期卒中护理与 ICH 和缺血性卒中后较低的长期死亡率相关，这强调了继续关注卒中护理提供者提供高质量早期护理的能力的重要性。
