Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International study

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dc.contributor.authorMuñoz Venturelli, Paula
dc.contributor.authorLi, Xian
dc.contributor.authorMiddleton, Sandy
dc.contributor.authorWatkins, Caroline
dc.contributor.authorLavados, Pablo
dc.contributor.authorOlavarría, Verónica
dc.contributor.authorBrunser, Alejandro
dc.contributor.authorPontes-Neto, Octavio
dc.contributor.authorSantos, Taiza
dc.contributor.authorHisatomi, Arima
dc.contributor.authorBillot, Laurent
dc.contributor.authorHackett, Maree
dc.contributor.authorSong, Lily
dc.contributor.authorRobinson, Thompson
dc.contributor.authorAnderson, Craig
dc.contributor.authorHEADPOST, Head positioning in acute
dc.date.accessioned2019-11-26T20:19:09Z
dc.date.available2019-11-26T20:19:09Z
dc.date.issued2019
dc.description.abstractBackground-—The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence-based processes of care for acute ischemic stroke (AIS) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results-—Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0–2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or “defect-free” care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18–1.65) and better survival (odds ratio, 2.23; 95% CI, 1.62–3.09). Defect-free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0–1) (odds ratio, 1.22; 95% CI, 1.04–1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions-—Use of evidence-based care is associated with improved clinical outcome in AIS. Strategies are required to address regional variation in the use of proven AIS treatments.
dc.format.extent19 p.
dc.identifier.citationJournal of the American Heart Association, 2019, v.8, n°13
dc.identifier.urihttp://hdl.handle.net/11447/2865
dc.language.isoen
dc.subjectAcute stroke care
dc.subjectMultilevel analysis
dc.subjectOutcome
dc.subjectQuality
dc.titleImpact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International study
dc.typeArticle

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