Processes of Care and Medical Complications in Patients With Stroke

Abstract

Background and Purpose— The relationship between processes of care and the risk of medical complications in patients with stroke remains unclear. We therefore examined the association in a population-based follow-up study. Methods— We identified 11 757 patients admitted for stroke to stroke units in 2 Danish counties in 2003 to 2008. The examined processes of care included early admission to a stroke unit, early initiation of antiplatelet or oral anticoagulant therapy, early CT/MRI scan, and early assessment by a physiotherapist and an occupational therapist of nutritional risk and of swallowing function and early mobilization. Results— Overall, 25.3% (n=2969) of the patients experienced ≥1 medical complications during hospitalization. The most common medical complications were urinary tract infection (15.5%), pneumonia (8.8%), and constipation (7.0%). We found indications of an inverse dose–response relationship between the number of processes of care that the patients received and the risk of medical complications. The lowest risk of complications was found among patients who received all relevant processes of care compared with patients who failed to receive any of the processes (ie, adjusted ORs ranged from 0.42 [95% CI, 0.24 to 0.74] for pressure ulcer to 0.64 [95% CI, 0.44 to 0.93] for pneumonia). Of the individual processes of care, early mobilization was associated with the lowest risk of complications. Conclusions— Higher quality of acute stroke care was associated with a lower risk of medical complications.