Is health-related quality of life between 90 and 180 days following stroke associated with long-term unmet needs?

Andrew, Nadine E.; Kilkenny, Monique F; Lannin, Natasha A.; Cadilhac, Dominique A.

doi:10.1007/s11136-016-1234-5

Cited by 29 publications

(22 citation statements)

References 28 publications

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“…It is also likely that those with worse HRQoL at 6 months will have more unmet needs at ≥12 months. 24 Similarly, those with milder stroke may have been more likely to be discharged directly to the community from acute care (only 13% in this subgroup went to residential aged care institutions). This may account for why the strength of the association for each of the bundles was lower in this group.…”

Section: Discussionmentioning

confidence: 97%

Quality of Acute Care and Long-Term Quality of Life and Survival

Cadilhac

Andrew

Lannin

et al. 2017

Stroke

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Stroke is a leading cause of death and adult disability, worldwide. Variability in the care provided to patients admitted to hospital with acute stroke can affect their recovery and is inefficient.1,2 Most studies of the outcomes after hospital care have focused on survival, discharge destination, or disability in the short term. Research on the quality of hospital Background and Purpose-Uncertainty exists over whether quality improvement strategies translate into better healthrelated 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%). We aimed to determine the relationship between receiving combinations of 3 recommended processes of acute care in hospital (referred herein as quality indicators) and patient outcomes ≤180 days after the onset of stroke, assessing the differences by stroke type. Conclusions-Patients MethodsThe data were from 42 hospitals participating in the Australian Stroke Clinical Registry (AuSCR) between 2010 and 2014. Staff from participating hospitals enter the data prospectively using the online system. Information includes patient characteristics, quality indicators, and health outcome measures.9,10 Longer-term patient outcomes are obtained centrally by AuSCR staff using survey methods (eg, for HRQoL) or annual data linkage to national death registrations.Eligible patients were aged ≥18 years with a diagnosis of ischemic stroke, intracerebral hemorrhage (ICH), or stroke of undetermined cause recorded by clinicians in the AuSCR database. For this study, the preference was to use ...

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Section: Discussionmentioning

confidence: 97%

Quality of Acute Care and Long-Term Quality of Life and Survival

Cadilhac

Andrew

Lannin

et al. 2017

Stroke

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“…7 Previous surveys on long-term unmet needs were focused on needs resulting from functional deficits after stroke such as the management of body functions, participation in daily activities, or needs induced by new social/environmental factors. 3,4,8,9 Consequently, data regarding unmet needs specifically related to critical aspects of long-term management such as post-acute care and secondary prevention are scarce. These 2 aspects deserve serious consideration in the overall assessment of unmet needs in survivors of not only stroke but also TIA.…”

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confidence: 99%

“…Moreover, demographic factors and the presence of certain disabilities/health problems have been associated with longterm unmet needs. 3,4,8,9 However, opportunity exists to explore previously unreported factors, especially those related to care and support services provided to survivors after hospital discharge. In this study, we extensively investigated long-term unmet needs in communitydwelling survivors of stroke/TIA across several domains, including post-acute care and secondary prevention, at $2 years after discharge.…”

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confidence: 99%

Long-term unmet needs and associated factors in stroke or TIA survivors

et al. 2017

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“…They will be stratified into two groups based on their responses: (1) without disability; and (2) with disability. An algorithm developed by the investigators will be used to identify those with ongoing disability severe enough to impact on their quality of life [26]. This is defined as having a problem in one or more of the five EQ-5D-3L domains and a clinically important (eight point or more) lower VAS score than what would be expected for people in the general population of a similar age [16,27].…”

Section: Discussionmentioning

confidence: 99%