Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study.
Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study.
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循证中风护理对患者预后的影响：国际研究的多层次分析。
DOI：
10.1161/jaha.119.012640
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发表时间：
2019
期刊：
影响因子：
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et al.
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作者：
Paula Muñoz Venturelli;Xian Li;Sandy Middleton;Caroline Watkins;Pablo M Lavados;Verónica V Olavarría;Alejandro Brunser;Octavio Pontes-Neto;Taiza E G Santos;Hisatomi Arima;et al.
研究背景：接受经证实的卒中治疗的患者差异很大。我们的目的是确定急性缺血性卒中（AIS）循证护理过程与参加HEADPOST的患者临床结局的相关性。（Head Positioning in Acute Stroke Trial），一项多中心的群组交叉试验，研究平躺与坐起、急性卒中中的头部定位。急性卒中单元护理;抗高血压、抗血小板、他汀类药物和房颤抗凝治疗;吞咽困难评估;和理疗师审查。采用分层、混合、逻辑回归模型确定与90天时良好结局（改良兰金量表评分0-2）的相关性，并根据患者和医院变量进行调整。在9485例AIS患者中，在合格患者中实施所有护理过程或“无缺陷”护理与改善结局（比值比，1.40; 95% CI，1.18-1.65）和更好的生存期（比值比，2.23; 95% CI，1.62-3.09）相关。无缺陷卒中护理也与良好结局显著相关（改良兰金量表评分0-1）（比值比，1.22; 95% CI，1.04-1.43）。没有医院特征能独立预测预后。只有1445（15%）符合条件的AIS患者接受了所有的护理过程，在整体和个体率方面存在显著的区域差异。需要制定策略来解决使用经证实的AIS治疗的区域差异。临床试验注册URL：https://www.clinicaltrials.gov。唯一标识符：NCT 02162017。
BackgroundThe 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 ResultsUse 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.ConclusionsUse 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.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov. Unique Identifier: NCT02162017.