Polhill Emma, Kilkenny Monique F, Cadilhac Dominique A, Lannin Natasha A, Dalli Lachlan L, Purvis Tara, Andrew Nadine E, Thrift Amanda G, Sundararajan Vijaya, Olaiya Muideen T
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia.
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC 3084, Australia.
Rev Cardiovasc Med. 2022 Sep 28;23(10):328. doi: 10.31083/j.rcm2310328. eCollection 2022 Oct.
Discharge planning is recommended to optimise the transition from acute care to home for patients admitted with stroke. Despite this guideline recommendation, many patients do not receive a discharge care plan. Also, there is limited evidence on factors influencing the provision of discharge care plan post-stroke. We evaluated patient, clinical and system factors associated with receiving a care plan on discharge from hospital back to the community after stroke.
This was an observational cohort study of patients with acute stroke who were discharged to the community between 2009-2013, using data from the Australian Stroke Clinical Registry linked to hospital administrative data. For this analysis, we used merged dataset containing information on patient demographics, clinical characteristics, and receipt of acute care processes. Multivariable logistic regression models were used to determine factors associated with receiving a discharge care plan.
Among 7812 eligible patients (39 hospitals, median age 73 years, 44.7% female, 56.9% ischaemic stroke), 47% received a care plan at discharge. The odds of receiving a discharge care plan increased over time (odds ratio [OR] 1.39 per year, 95% CI 1.37-1.48), and varied between hospitals. Factors associated with receiving a discharge care plan included greater socioeconomic position (OR 1.18, 95% CI 1.02-1.38), diagnosis of ischaemic stroke (OR 1.18, 95% CI 1.05-1.33), greater stroke severity (OR 1.15, 95% CI 1.01-1.31), or being discharged on antihypertensive medication (OR 3.07, 95% CI 2.69-3.50). In contrast, factors associated with a reduced odds of receiving a discharge care plan included being aged 85+ years ( 85 years; OR 0.79, 95% CI 0.64-0.96), discharged on a weekend (OR 0.56, 95% CI 0.46-0.67), discharged to residential aged care (OR 0.48, 95% CI 0.39-0.60), or being treated in a large hospital ( 300 beds; OR 0.30, 95% CI 0.10-0.92).
Implementing practices to target people who are older, discharged to residential aged care, or discharged on a weekend may improve discharge planning and post-discharge care after stroke.
对于因中风入院的患者，建议进行出院计划以优化从急性护理到家庭的过渡。尽管有这一指南建议，但许多患者并未收到出院护理计划。此外，关于影响中风后出院护理计划提供的因素的证据有限。我们评估了与中风后出院回社区时接受护理计划相关的患者、临床和系统因素。
这是一项对2009年至2013年间出院至社区的急性中风患者的观察性队列研究，使用了与医院行政数据相关联的澳大利亚中风临床登记处的数据。对于本分析，我们使用了包含患者人口统计学、临床特征以及急性护理流程接受情况信息的合并数据集。多变量逻辑回归模型用于确定与接受出院护理计划相关的因素。
在7812名符合条件的患者中（39家医院，中位年龄73岁，44.7%为女性，56.9%为缺血性中风），47%在出院时收到了护理计划。接受出院护理计划的几率随时间增加（优势比[OR]为每年1.39，95%置信区间1.37 - 1.48），且在不同医院之间有所差异。与接受出院护理计划相关的因素包括较高的社会经济地位（OR 1.18，95%置信区间1.02 - 1.38）、缺血性中风诊断（OR 1.18，95%置信区间1.05 - 1.33）、较高的中风严重程度（OR 1.15，95%置信区间1.01 - 1.31）或出院时服用抗高血压药物（OR 3.07，95%置信区间2.69 - 3.50）。相比之下，与接受出院护理计划几率降低相关的因素包括年龄在85岁及以上（≥85岁；OR 0.79，95%置信区间0.64 - 0.96）、在周末出院（OR 0.56，95%置信区间0.46 - 0.67）、出院至老年护理机构（OR 0.48，95%置信区间0.39 - 0.60）或在大型医院接受治疗（≥300张床位；OR 0.30，95%置信区间0.10 - 0.92）。
针对年龄较大、出院至老年护理机构或在周末出院的人群实施相关措施，可能会改善中风后的出院计划和出院后护理。
