BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
AD - 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.). dominique.cadilhac@monash.edu.BACKGROUND AND PURPOSE: 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. METHODS: 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. RESULTS: 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%). CONCLUSIONS: Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL.
PY - 2017 SN - 1524-4628 (Electronic)