Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence.
Hospital Factors, Performance on Process Measures After Transient Ischemic Attack, and 90-Day Ischemic Stroke Incidence.
复制标题
DOI：
10.1161/strokeaha.120.031721
复制
发表时间：
2021-07
期刊：
影响因子：
8.3
通讯作者：
Bravata DM
中科院分区：
文献类型：
--
作者：
Levine DA;Perkins AJ;Sico JJ;Myers LJ;Phipps MS;Zhang Y;Bravata DM
我们确定了医院因素、短暂性脑缺血发作（TIA）过程指标的表现和90天缺血性卒中发病率之间的相关性。对回顾性获得的9，168名患有TIA的退伍军人的数据进行纵向分析，这些退伍军人在69家退伍军人事务医院的急诊室（艾德）或住院部就诊，2015-2018财年每年有≥10名符合条件的患者。过程措施为出院后7天内使用高/中效他汀类药物，第2天抗血栓形成;第90天控制高血压[<140/90 mm Hg]。结果为90天卒中发生率。在4年的研究期间，医院显著增加了他汀类药物的使用（每增加1年的调整比值比[aOR]为1.24 [95%CI，1.17-1.32]; P<0.001），而高血压控制（P=0.44）和抗血栓药物的使用（P=0.82）均未随时间推移而改善。入院TIA患者比例高于出院艾德患者比例的医院，他汀类药物的使用率显著高于其他医院（入院TIA患者比例每增加10个百分点的aOR为1.09 [1.03-1.16]; P=0.003），抗血栓药物的使用率显著高于其他医院（入院TIA患者比例每增加10个百分点的aOR为1.14 [1.06-1.23]; P<0.001）。艾德医师人数较多且TIA患者数量较少的医院使用抗血栓药物较多（每名全职医师增加的aOR为1.05 [1.01-1.08]; P=0.008），每10名患者减少的aOR为1.09 [1.01-1.16]; P=0.02）。较高的艾德医生配备与较低的90天卒中发病率相关（每增加一名全职医生的aOR，0.96 [0.92-0.99]; P=0.02），但其他医院因素则无关。收治TIA患者比例较高且拥有较高艾德医师配置的医院在选择TIA指南一致性流程措施方面表现更好。较高的艾德医师配备与TIA后90天的结局改善相关。
We determined the association between hospital factors, performance on transient ischemic attack (TIA) process measures, and 90-day ischemic stroke incidence. Longitudinal analysis of retrospectively-obtained data on 9,168 veterans ≥18 years with TIA presenting to the Emergency Department (ED) or inpatient unit at 69 Veterans Affairs hospitals with ≥10 eligible patients per year in fiscal years 2015-2018. Process measures were high/moderate potency statin within 7 days of discharge, anti-thrombotic by day 2; and hypertension control [<140/90 mm Hg] at 90 days. The outcome was 90-day stroke incidence. Over the four-year study period, hospitals significantly increased statin use (adjusted odds ratio [aOR] per 1-year increase, 1.24 [95% CI, 1.17-1.32]; P<0.001), whereas neither hypertension control (P=0.44) nor anti-thrombotic use (P=0.82) improved over time. Hospitals that admitted a higher proportion of TIA patients vs ED discharge had significantly greater use of statins (aOR per 10-percentage point increase in the proportion of TIA patients admitted, 1.09 [1.03-1.16]; P=0.003) and anti-thrombotics (aOR per 10-percentage point increase in TIA patients admitted, 1.14 [1.06-1.23]; P<0.001). Hospitals with higher ED physician staffing and lower TIA patient volume had greater use of anti-thrombotics (aOR per one full-time physician increase, 1.05 [1.01-1.08]; P=0.008) and aOR per 10-patient decrease in volume, 1.09 [1.01-1.16]; P=0.02). Higher ED physician staffing was associated with lower 90-day stroke incidence (aOR per one full-time physician increase, 0.96 [0.92-0.99]; P=0.02) but other hospital factors were not. Hospitals admitting higher percentages of TIA patients and having higher ED physician staffing have greater performance on select guideline-concordant process measures for TIA. Higher ED physician staffing was associated with improved outcomes 90 days after TIA.