title: Implementing a simple care bundle is associated with improved outcomes in a national cohort of patients with ischemic stroke.
abstract: OBJECTIVE
  Further research is needed to better identify the methods of evaluating processes and outcomes of stroke care. We investigated whether achieving 4 evidence-based components of a care bundle in a Scotland-wide population with ischemic stroke is associated with 30-day and 6-month outcomes.
  
  
  METHODS
  Using national datasets, we looked at the effect of 4 standards (stroke unit entry on calendar day of admission [day 0] or day following [day 1], aspirin on day 0 or day 1, scan on day 0, and swallow screen recorded on day 0) on mortality and discharge to usual residence, at 30 days and 6 months. Data were corrected for the validated 6 simple variables, admission year, and hospital-level random effects.
  
  
  RESULTS
  A total of 36,055 patients were included. Achieving stroke unit admission, swallow screen, and aspirin standards were associated with reduced 30-day mortality (adjusted odds ratio [95% confidence interval]: 0.82 [0.75-0.90], 0.88 [0.77-0.99], and 0.39 [0.35-0.43], respectively). Thirty-day all-cause mortality was higher when fewer standards were achieved, from 0 versus 4 (adjusted odds ratio [95% confidence interval], 2.95 [1.91-4.55]) to 3 versus 4 (adjusted odds ratio [95% confidence interval], 1.21 [1.09-1.34]). This effect persisted at 6 months. When less than the full care bundle was achieved, discharge to usual residence was less likely at 6 months (3 versus 4 standards; adjusted odds ratio [95% confidence interval], 0.91 [0.85-0.98]).
  
  
  CONCLUSIONS
  Achieving a care bundle for ischemic stroke is associated with reduced mortality at 30 days and 6 months and increased likelihood of discharge to usual residence at 6 months.
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: Melanie
authors: M
authors: Turner
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: Mark
authors: M
authors: Barber
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: Hazel
authors: H
authors: Dodds
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: David
authors: D
authors: Murphy
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: Martin
authors: M
authors: Dennis
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.).
authors: Peter
authors: P
authors: Langhorne
authors: From the Division of Applied Medicine, University of Aberdeen, Aberdeen, United Kingdom (M.T., M.-J.M.); Stroke Unit, Monklands Hospital, Lanarkshire, United Kingdom (M.B.); Information Services Division, National Services Scotland, Edinburgh, United Kingdom (H.D., D.M.); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (M.D.); and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.L.). m.j.macleod@abdn.ac.uk.
authors: Mary-Joan
authors: MJ
authors: Macleod
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015331:Cohort Studies; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D064872:Patient Care Bundles / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome
keywords: patient outcome assessment; selection bias; standards; survival