Nina Sahlertz Kristiansen1, Jan Mainz2, Bente Mertz Nørgård2, Paul D Bartels2, Grethe Andersen2, Søren Paaske Johnsen2. 1. From the Centre for Quality, Region of Southern Denmark, Middelfart, Denmark (N.S.K.); Institute of Public Health (N.S.K.), and Research Unit of Clinical Epidemiology, Institute of Clinical Research (B.M.N.), University of Southern Denmark, Odense, Denmark; Aalborg Psychiatric University Hospital, and Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark (J.M.); Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark (B.M.N.); The Danish Clinical Registries, Aarhus, Denmark (P.D.B.); Department of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark (P.D.B.); and Department of Neurology (G.A.) and Department of Clinical Epidemiology (S.P.J.), Aarhus University Hospital, Aarhus, Denmark. nskristiansen@health.sdu.dk. 2. From the Centre for Quality, Region of Southern Denmark, Middelfart, Denmark (N.S.K.); Institute of Public Health (N.S.K.), and Research Unit of Clinical Epidemiology, Institute of Clinical Research (B.M.N.), University of Southern Denmark, Odense, Denmark; Aalborg Psychiatric University Hospital, and Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark (J.M.); Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark (B.M.N.); The Danish Clinical Registries, Aarhus, Denmark (P.D.B.); Department of Clinical Medicine, Faculty of Medicine, University of Aalborg, Aalborg, Denmark (P.D.B.); and Department of Neurology (G.A.) and Department of Clinical Epidemiology (S.P.J.), Aarhus University Hospital, Aarhus, Denmark.
Abstract
BACKGROUND AND PURPOSE: Studies have reported higher risks of death and other adverse outcomes in acute stroke patients admitted off-hours; however, little is known about the underlying mechanisms. According to time of admission, our aim was to examine compliance with performance measures for acute stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. METHODS: A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64 975). Off-hours were weekends and evening and nighttime shifts on weekdays. Compliance with performance measures was compared using general linear modeling, and odds ratios for 30 days case-fatality were obtained using multivariable logistic regression. RESULTS: Patients admitted off-hours had a lower chance of compliance with 8 out of 10 performance measures; however, these differences diminished over time. Unadjusted odds ratio for 30 days case-fatality, for patients admitted off-hours compared with patients admitted on-hours, was 1.15 (95% confidence interval, 1.09-1.21). Adjusting for patient characteristics (in particular, stroke severity) decreased the odds ratio to 1.03 (95% confidence interval, 0.97-1.10). Additional adjustment for hospital characteristics and compliance with performance measures had no effect on the odds ratio. CONCLUSION: Patients admitted off-hours received a poorer quality of care. However, the admission time-related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity.
BACKGROUND AND PURPOSE: Studies have reported higher risks of death and other adverse outcomes in acute strokepatients admitted off-hours; however, little is known about the underlying mechanisms. According to time of admission, our aim was to examine compliance with performance measures for acute stroke care processes, including the effect of a systematic quality improvement program, and to examine 30 days case-fatality. METHODS: A population-based historical cohort study, including patients admitted to Danish hospitals with a first ever acute stroke (January 1, 2003, to December 31, 2011; N=64 975). Off-hours were weekends and evening and nighttime shifts on weekdays. Compliance with performance measures was compared using general linear modeling, and odds ratios for 30 days case-fatality were obtained using multivariable logistic regression. RESULTS:Patients admitted off-hours had a lower chance of compliance with 8 out of 10 performance measures; however, these differences diminished over time. Unadjusted odds ratio for 30 days case-fatality, for patients admitted off-hours compared with patients admitted on-hours, was 1.15 (95% confidence interval, 1.09-1.21). Adjusting for patient characteristics (in particular, stroke severity) decreased the odds ratio to 1.03 (95% confidence interval, 0.97-1.10). Additional adjustment for hospital characteristics and compliance with performance measures had no effect on the odds ratio. CONCLUSION:Patients admitted off-hours received a poorer quality of care. However, the admission time-related differences in care were substantially reduced over time, and the differences in 30 days case-fatality appeared primarily to be explained by differences in stroke severity.
Authors: Valerian L Altersberger; Patrick R Wright; Sabine A Schaedelin; Gian Marco De Marchis; Henrik Gensicke; Stefan T Engelter; Marios Psychogios; Timo Kahles; Martina Goeldlin; Thomas R Meinel; Pasquale Mordasini; Johannes Kaesmacher; Alexander von Hessling; Jochen Vehoff; Johannes Weber; Susanne Wegener; Stephan Salmen; Rolf Sturzenegger; Friedrich Medlin; Christian Berger; Ludwig Schelosky; Susanne Renaud; Julien Niederhauser; Christophe Bonvin; Michael Schaerer; Marie-Luise Mono; Biljana Rodic; Guido Schwegler; Nils Peters; Manuel Bolognese; Andreas R Luft; Carlo W Cereda; Georg Kägi; Patrick Michel; Emmanuel Carrera; Marcel Arnold; Urs Fischer; Krassen Nedeltchev; Leo H Bonati Journal: Eur Stroke J Date: 2022-04-27
Authors: Dustin W Ballard; Anthony S Kim; Jie Huang; David K Park; Mamata V Kene; Uli K Chettipally; Hilary R Iskin; John Hsu; David R Vinson; Dustin G Mark; Mary E Reed Journal: Ann Emerg Med Date: 2015-09-08 Impact factor: 5.721
Authors: Jonas F Ludvigsson; Siri E Håberg; Gun Peggy Knudsen; Pierre Lafolie; Helga Zoega; Catharina Sarkkola; Stephanie von Kraemer; Elisabete Weiderpass; Mette Nørgaard Journal: Clin Epidemiol Date: 2015-11-23 Impact factor: 4.790