Sage Journals: Discover world-class research

Abstract

Background

Stroke coordinators have been inconsistently used in various countries to support stroke care in hospital.

Aim

To investigate the association between stroke coordinators and the provision of evidence-based care and patient outcomes in hospitals with acute stroke units.

Methods

Observational study using cross-sectional data from the 2015 National Acute Services Audit Program (Australia): including a retrospective medical record audit (40 records from each hospital) and a self-reported survey of organizational resources for stroke. Multilevel random effects logistic regression for patient outcomes including complications, independence on discharge, and death. Median regression for length of stay comparisons.

Results

A total of 109 hospitals submitted 4060 cases; 59 (54%) had a stroke coordinator. Compared with patients from stroke unit hospitals with no stroke coordinator (N = 33, 1333 cases), patients in stroke unit hospitals with a stroke coordinator (N = 53, 2072 cases) were more likely to receive clinical practices including rehabilitation therapy within 48 hours of initial assessment (88 vs. 82%, p < 0.001), risk factor modification advice (62 vs. 55%, p = 0.003) and receive a discharge care plan (65 vs. 48%, p < 0.001). No differences in complications, independence on discharge, or deaths were evident. Patients from hospitals with a stroke coordinator were more likely to access inpatient rehabilitation (adjusted odds ratio 1.8, 95% confidence interval 1.1–2.8) and have a reduced length of acute stay if discharged (median 14 h, p = 0.03).

Conclusion

Presence of stroke coordinators was associated with reduced length of stay and improved delivery of evidence-based care in hospitals with a stroke unit.

Keywords

Stroke health services research health policy outcomes coordinator quality improvement

Get full access to this article

View all access options for this article.

References

Australian Institute of Health and Welfare. Stroke and its management in Australia: an update. Cardiovascular Disease Series no.37. Cat No. CVD 61. Canberra: AIHW, 2013.

Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2013; Art No.: CD000197.

Purvis

Bernhardt

Indredavik

Cadilhac

. Interdisciplinary team interactions in stroke units: can team dynamics influence patient outcomes from a clinician's perspective. Int J Phys Med Rehabil 2014; S3: 007.

Langhorne

Pollack

. What are the components of effective stroke unit care? Age Ageing 2002; 31: 365–371.

Cadilhac

Purvis

Bernhardt

Korner-Bitensky

Organization of care. In: Carey

(ed). Stroke rehabilitation. Insights from neuroscience and imaging, New York: Oxford University Press, 2012.

National Stroke Foundation. Clinical guidelines for stroke management 2010, Melbourne: NSF, 2010.

Alberts

Latchaw

Selman

et al.

Recommendations for comprehensive stroke centers: a consensus statement from the Brain Attack Coalition. Stroke 2005; 36: 1597–1616.

McDonald

Mayer

Dunn

. National service framework for older people: stroke coordinators. Br J Nurs 2002; 11: 1259–1265.

Murray

Forster

Young

. Survey to investigate the role of the community stroke care coordinator. Br J Community Nurs 2008; 13: 31–36.

10.

Freijser

Naccarella

McKenzie

Krishnasamy

. Cancer care coordination: building a platform for the development of care coordinator roles and ongoing evaluation. Aust J Prim Health 2015; 21: 157–163.

11.

Purvis

Moss

Denisenko

Bladin

Cadilhac

. Implementation of evidence-based stroke care: enablers, barriers, and the role of facilitators. J Multidisciplinary Healthcare 2014; 7: 389–400.

12.

Cadilhac

Purvis

Kilkenny

et al.

Evaluation of rural stroke services: does implementation of coordinators and pathways improve care in rural hospitals?

Stroke 2013; 44: 2848–2853.

13.

National Stroke Foundation. National Stroke Audit – Acute Services Report 2015, Melbourne: NSF, 2015.

14.

Australian Commission on Safety and Quality in Health Care. Acute stroke clinical care standard, Sydney: ACSQHC, 2015.

15.

Austin

. Using the standardized difference to compare the prevalence of a binary variable between two groups in observational research. Comm Stat Simulat Comput 2009; 38: 1228–1234.

16.

Bamford

Sandercock

Warlow

Slattery

. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1989; 20: 828.

17.

Counsell

Dennis

McDowall

Warlow

. Predicting outcome after acute and subacute stroke: development and validation of new prognostic models. Stroke 2002; 33: 1041–1047.

18.

Department of Health. National service framework for older people. London: DoH, 2001.

19.

Burton

. An exploration of the stroke co-ordinator role. J Clin Nurs 1999; 8: 535–541.

20.

Green

Newcommon

. Advancing nursing practice: the role of the nurse practitioner in an acute stroke program. J Neurosci Nurs 2006; 38: 328–330.

21.

Summers

Leonard

Wentworth

et al.

Comprehensive overview of nursing and interdisciplinary care of the acute ischemic stroke patient: a scientific statement from the American Heart Association. Stroke 2009; 40: 2911–2944.

22.

Collinson

Foster

Stapleton

Blakey

. Cancer care coordinators: what are they and what will they cost? New Zeal Med J 2013; 126: 75–86.

23.

Sheedy

Bernhardt

Levi

et al.

Are patients with intracerebral haemorrhage disadvantaged in hospitals?

Int J Stroke 2014; 9: 437–442.

24.

Blakely

Collinson

Kvizhinadze

et al.

Cancer care coordinators in stage III colon cancer: a cost-utility analysis. BMC Health Serv Res 2015; 15: 306.

25.

The University of York. Evaluation of the British Heart Foundation Arrhythmia Care Co-ordinator Services, London: British Heart Foundation, 2010.

26.

Maddux

Usvyat

DeFalco

et al.

Effects of renal care coordinator case managment on outcomes in incident dialysis patients. Clini Nephrol 2016; 85: 152–158.

27.

Stewart

Wilson

Bergquist

Thorburn

. Care coordinators: a controlled evaluation of an inpatient mental health service innovation. Int J Mental Health Nurs 2012; 21: 82–91.

28.

De Wit

Putman

Dejaeger

et al.

Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke 2005; 36: 1977–1983.

29.

National Stroke Foundation. National Stroke Audit Acute Services Organisational Survey Report 2013, Melbourne: NSF, 2013.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.44 MB

Influence of stroke coordinators on delivery of acute stroke care and hospital outcomes: An observational study

Abstract

Background

Aim

Methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material