Patient-Level and Hospital-Level Determinants of the Quality of Acute Stroke Care

Background and Purpose—The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care.\ud \ud Methods—We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less.\ud \ud Results—Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03–1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01–1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06–1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care.\ud \ud Conclusions—There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care

Section: Quality Of Carementioning

confidence: 99%

Socioeconomic Status and the Quality of Acute Stroke Care

Pan

Chen

et al. 2016

“…3 According to our knowledge, only 3 existing studies have compared quality of stroke care between high-and low-volume institutions. One study (not restricted to stroke units) showed that higher hospital bed size was associated with better quality of stroke care, 21 whereas other studies found no direct link between volume and quality of care. 17,18 In our study, adjusting for the percentage of received processes of care had no major influence on the results.…”

Section: November 2012mentioning

confidence: 99%

Higher Stroke Unit Volume Associated With Improved Quality of Early Stroke Care and Reduced Length of Stay

Svendsen

Ehlers

Ingeman

et al. 2012

Background and Purpose— Specialized stroke unit care improves outcome among patients with stroke, but it is unclear whether there are any scale advantages in costs and clinical outcome from treating a larger number of patients. We examined whether the case volume in stroke units was associated with quality of early stroke care, mortality, and hospital bed-day use. Methods— In a nationwide population-based cohort study, we identified 63 995 patients admitted to stroke units in Denmark between 2003 and 2009. Data on exposure, outcome, and covariates were collected prospectively. Comparisons were clustered within stroke units and adjusted for patient and hospital characteristics. Results— Patients in high-volume stroke units overall had a better prognostic profile than patients in low-volume stroke units. Patients in high-volume stroke units also received more processes of care in the early phase of stroke compared with patients in low-volume stroke units (unadjusted difference, 9.84 percentage points; 95% CI, 3.98–15.70). High stroke unit volume was associated with shorter length of the initial hospital stay (adjusted ratio, 0.49; 95% CI, 0.41–0.59) and reduced bed-day use in the first year after stroke (adjusted ratio, 0.79; 95% CI, 0.70–0.87). No association between volume and mortality was found. Conclusions— Patients admitted to high-volume stroke units received a higher quality of early stroke care and spent fewer days in the hospital compared with patients in low-volume units. We observed no association between volume and mortality.

“…5 The Paul Coverdell National Acute Stroke Registry found that quality of stroke care summarized as a composite of 8 performance measures varied by state in unadjusted, but not in risk-adjusted, analyses. 20 The reasons for these regional differences in GWTGStroke hospitals and other registries and programs remain unclear. Previous studies suggest that regional patterns of care, particularly for treatments such as IV-tPA, for which relatively few stroke patients are eligible, may reflect differences in hospital characteristics, such as bed capacity or teaching status; yet, we found that differences persisted after adjustment for these characteristics.…”

Section: Allen Et Al Variation In Ischemic Stroke and Tia Treatmentsmentioning

confidence: 99%

Regional Variation in Recommended Treatments for Ischemic Stroke and TIA

Allen

Kaltenbach

Goldstein

et al. 2012

Self Cite

Background and Purpose-Secondary stroke prevention treatments vary in different regions of the US. We determined the degree to which guideline-recommended stroke treatments vary by region for patients treated at hospitals participating in a voluntary national quality improvement program, Get With The Guidelines-Stroke. Methods-Receipt of 8 guideline-recommended treatments (intravenous tissue-type plasminogen activator, antihypertensives, antithrombotics, anticoagulants for atrial fibrillation, deep vein thrombosis prophylaxis, lipid-lowering medications at discharge, smoking cessation counseling, weight loss education) and defect-free care were compared in 4 US regions among eligible patients with ischemic stroke and transient ischemic attack; there was adjustment for patient demographics, medical history, and hospital characteristics. Results-Among