Processes of Care Associated With Acute Stroke Outcomes
Processes of Care Associated With Acute Stroke Outcomes
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DOI：
10.1001/archinternmed.2010.92
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发表时间：
2010-05-10
影响因子：
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通讯作者：
Concato, John
中科院分区：
文献类型：
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作者：
Bravata, Dawn M.;Wells, Carolyn K.;Concato, John
背景：许多护理过程已被提出作为评估中风护理的指标。我们试图确定中风护理的过程中，与改善患者的预后后，调整患者的特点和其他过程measures.Methods：这项回顾性队列研究包括患者18岁或以上的缺血性中风或短暂性脑缺血发作（TIA）发病不超过2天前入院和入院时的神经功能缺损。如果患者居住在专业护理机构，在卒中发作时已经入院，或从另一家急诊护理机构转移，则将其排除在外。综合结局包括住院死亡率、出院至临终关怀或出院至专业护理机构。评估了卒中护理的七个过程：发热管理、缺氧管理、血压管理、神经功能评估、吞咽评估、深静脉血栓形成（DVT）预防和早期动员。风险调整包括年龄，合并症（病史），入院时存在的伴随医学疾病，入院前症状病程，卒中前功能状态，代码状态，卒中严重程度，非神经系统状态，改良的APACHE（急性生理学和慢性健康评估）III评分，和入院脑影像学findings.Results：在1487例患者中，观察到239（16%）的结果。三个护理过程与调整后结果的改善独立相关：吞咽评估（校正比值比[OR]，0.64; 95%置信区间[CI]，0.43-0.94）; DVT预防（调整后的OR，0.60; 95%CI，0.37-0.96）;并通过补充氧气治疗所有缺氧发作结论：重视吞咽功能、预防DVT和治疗缺氧可改善缺血性卒中或TIA患者的预后。《内科学文献》2010;170（9）：804-810
Background: Many processes of care have been proposed as metrics to evaluate stroke care. We sought to identify processes of stroke care that are associated with improved patient outcomes after adjustment for both patient characteristics and other process measures.Methods: This retrospective cohort study included patients 18 years or older with an ischemic stroke or transient ischemic attack (TIA) onset no more than 2 days before admission and a neurologic deficit on admission. Patients were excluded if they resided in a skilled nursing facility, were already admitted to the hospital at stroke onset, or were transferred from another acute-care facility. The combined outcome included in-hospital mortality, discharge to hospice, or discharge to a skilled nursing facility. Seven processes of stroke care were evaluated: fever management, hypoxia management, blood pressure management, neurologic evaluation, swallowing evaluation, deep vein thrombosis (DVT) prophylaxis, and early mobilization. Risk adjustment included age, comorbidity (medical history), concomitant medical illness present at admission, preadmission symptom course, prestroke functional status, code status, stroke severity, nonneurologic status, modified APACHE (Acute Physiology and Chronic Health Evaluation) III score, and admission brain imaging findings.Results: Among 1487 patients, the outcome was observed in 239 (16%). Three processes of care were independently associated with an improvement in the outcome after adjustment: swallowing evaluation (adjusted odds ratio [OR], 0.64; 95% confidence interval [CI], 0.43-0.94); DVT prophylaxis (adjusted OR, 0.60; 95% CI, 0.37-0.96); and treating all episodes of hypoxia with supplemental oxygen (adjusted OR, 0.26; 95% Cl, 0.09-0.73).Conclusion: Outcomes among patients with ischemic stroke or TIA can be improved by attention to swallowing function, DVT prophylaxis, and treatment of hypoxia. Arch Intern Med. 2010;170(9):804-810