Impact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study

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Autor(es): dc.contributorUniversidade Estadual Paulista (UNESP)-
Autor(es): dc.creatorVenturelli, Paula Munoz-
Autor(es): dc.creatorLi, Xian-
Autor(es): dc.creatorMiddleton, Sandy-
Autor(es): dc.creatorWatkins, Caroline-
Autor(es): dc.creatorLavados, Pablo M.-
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Autor(es): dc.creatorRobinson, Thompson-
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Autor(es): dc.creatorWatkins, Caroline L.-
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Autor(es): dc.creatorHEADPOST Head Positioning In Acute-
Data de aceite: dc.date.accessioned2021-03-11T01:17:43Z-
Data de disponibilização: dc.date.available2021-03-11T01:17:43Z-
Data de envio: dc.date.issued2019-10-04-
Data de envio: dc.date.issued2019-10-04-
Data de envio: dc.date.issued2019-07-02-
Fonte completa do material: dc.identifierhttp://dx.doi.org/10.1161/JAHA.119.012640-
Fonte completa do material: dc.identifierhttp://hdl.handle.net/11449/186143-
Fonte: dc.identifier.urihttp://educapes.capes.gov.br/handle/11449/186143-
Descrição: dc.descriptionNational Health and Medical Research Council of Australia-
Descrição: dc.descriptionNational Health and Medical Research Council of Australia: 1066966-
Descrição: dc.descriptionBackground-The 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 Results-Use 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. Conclusions-Use 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.-
Formato: dc.format19-
Idioma: dc.languageen-
Publicador: dc.publisherWiley-Blackwell-
Relação: dc.relationJournal Of The American Heart Association-
Direitos: dc.rightsopenAccess-
Palavras-chave: dc.subjectacute stroke care-
Palavras-chave: dc.subjectmultilevel analysis-
Palavras-chave: dc.subjectoutcome-
Palavras-chave: dc.subjectquality-
Título: dc.titleImpact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study-
Tipo de arquivo: dc.typelivro digital-
Aparece nas coleções:Repositório Institucional - Unesp

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