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Title: | Association between patient outcomes and key performance indicators of stroke care quality: A systematic review and meta-analysis. | Authors: | Cadilhac D.A.;Urimubenshi G.;Langhorne P.;Kagwiza J.N.;Wu O. | Institution: | (Urimubenshi, Langhorne) University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow, United Kingdom (Urimubenshi, Kagwiza) College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda (Cadilhac) School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (Cadilhac) The Florey Institute Neuroscience and Mental Health, University of Melbourne, VIC, Australia (Wu) Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom | Issue Date: | 25-Nov-2017 | Copyright year: | 2017 | Publisher: | SAGE Publications Ltd (E-mail: info@sagepub.co.uk) | Place of publication: | United Kingdom | Publication information: | European Stroke Journal. 2 (4) (pp 287-307), 2017. Date of Publication: 01 Dec 2017. | Abstract: | Purpose: Translating research evidence into clinical practice often uses key performance indicators to monitor quality of care. We conducted a systematic review to identify the stroke key performance indicators used in large registries, and to estimate their association with patient outcomes. Method(s): We sought publications of recent (January 2000-May 2017) national or regional stroke registers reporting the association of key performance indicators with patient outcome (adjusting for age and stroke severity). We searched Ovid Medline, EMBASE and PubMed and screened references from bibliographies. We used an inverse variance random effects meta-analysis to estimate associations (odds ratio; 95% confidence interval) with death or poor outcome (death or disability) at the end of follow-up. Finding(s): We identified 30 eligible studies (324,409 patients). The commonest key performance indicators were swallowing/nutritional assessment, stroke unit admission, antiplatelet use for ischaemic stroke, brain imaging and anticoagulant use for ischaemic stroke with atrial fibrillation, lipid management, deep vein thrombosis prophylaxis and early physiotherapy/mobilisation. Lower case fatality was associated with stroke unit admission (odds ratio 0.79; 0.72-0.87), swallow/nutritional assessment (odds ratio 0.78; 0.66-0.92) and antiplatelet use for ischaemic stroke (odds ratio 0.61; 0.50-0.74) or anticoagulant use for ischaemic stroke with atrial fibrillation (odds ratio 0.51; 0.43-0.64), lipid management (odds ratio 0.52; 0.38-0.71) and early physiotherapy or mobilisation (odds ratio 0.78; 0.67-0.91). Reduced poor outcome was associated with adherence to swallowing/nutritional assessment (odds ratio 0.58; 0.43-0.78) and stroke unit admission (odds ratio 0.83; 0.77-0.89). Adherence with several key performance indicators appeared to have an additive benefit. Discussion(s): Adherence with common key performance indicators was consistently associated with a lower risk of death or disability after stroke. Conclusion(s): Policy makers and health care professionals should implement and monitor those key performance indicators supported by good evidence.Copyright © 2017, © European Stroke Organisation 2017. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1177/2396987317735426 | ORCID: | Urimubenshi, Gerard; ORCID: http://orcid.org/0000-0002-0319-2912 | Link to associated publication: | Click here for full text options | ISSN: | 2396-9873 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38289 | Type: | Review | Subjects: | *cerebrovascular accident deep vein thrombosis/dt [Drug Therapy] deep vein thrombosis/pc [Prevention] disability/co [Complication] disease association disease severity drug effect drug use follow up *health care quality human meta analysis nutritional assessment outcome assessment priority journal review swallowing systematic review thrombosis prevention treatment planning antithrombocytic agent/dt [Drug Therapy] atrial fibrillation case fatality rate age cause of death human meta analysis nutritional assessment outcome assessment priority journal Review swallowing systematic review thrombosis prevention treatment planning disease association disease severity deep vein thrombosis / drug therapy / prevention *cerebrovascular accident cause of death case fatality rate atrial fibrillation age disability / complication drug effect drug use follow up *health care quality |
Type of Clinical Study or Trial: | Systematic review and/or meta-analysis |
Appears in Collections: | Articles |
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