Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an auditReport as inadecuate




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BMC Health Services Research

, 6:16

First Online: 23 February 2006Received: 20 October 2005Accepted: 23 February 2006DOI: 10.1186-1472-6963-6-16

Cite this article as: Taylor, W.J., Wong, A., Siegert, R.J. et al. BMC Health Serv Res 2006 6: 16. doi:10.1186-1472-6963-6-16

Abstract

BackgroundOrganised stroke care saves lives and reduces disability. A clinical pathway might be a form of organised stroke care, but the evidence for the effectiveness of this model of care is limited.

MethodsThis study was a retrospective audit study of consecutive stroke admissions in the setting of an acute general medical unit in a district general hospital. The case-notes of patients admitted with stroke for a 6-month period before and after introduction of the pathway, were reviewed to determine data on length of stay, outcome, functional status, Barthel Index, BI and Modified Rankin Scale, MRS, Oxfordshire Community Stroke Project OCSP sub-type, use of investigations, specific management issues and secondary prevention strategies. Logistic regression was used to adjust for differences in case-mix.

ResultsN = 77 prior to the pathway and 76 following the pathway. The median interquartile range, IQR age was 78 years 67.75–84.25, 88% were European NZ and 37% were male. The median IQR BI at admission for the pre-pathway group was less than the post-pathway group: 6 0–13.5 vs. 10 4–15.5, p = 0.018 but other baseline variables were statistically similar. There were no significant differences between any of the outcome or process of care variables, except that echocardiograms were done less frequently after the pathway was introduced. A good outcome MRS<4 was obtained in 66.2% prior to the pathway and 67.1% after the pathway. In-hospital mortality was 20.8% and 23.1%. However, using logistic regression to adjust for the differences in admission BI, it appeared that admission after the pathway was introduced had a significant negative effect on the probability of good outcome OR 0.29, 95%CI 0.09-0.99.

ConclusionA clinical pathway for acute stroke management appeared to have no benefit for the outcome or processes of care and may even have been associated with worse outcomes. These data support the conclusions of a recent Cochrane review.

List of abbreviationsBIBarthel Index

MRSModified Rankin Scale

ICD-10International Classification of Disease 10 edition

OCSPOxfordshire Community Stroke Project

SPSSStatistics Package for the Social Sciences

LOSLength of stay

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-6-16 contains supplementary material, which is available to authorized users.

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Author: William J Taylor - Annie Wong - Richard J Siegert - Harry K McNaughton

Source: https://link.springer.com/



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