Quality and outcomes of acute stroke care for people with and without aphasia.
To investigate whether presence of aphasia was associated with differences in acute stroke care quality; and to describe in-hospital outcomes.
Observational cohort study of cross-sectional data from the biennial Stroke Foundation National Stroke Audit of Acute Services (2017, 2019 and 2021). Descriptive statistics and multivariable regression models were used to compare quality of care and in-hospital outcomes by aphasia status (care adjusted for hospital variation; outcomes adjusted for age, sex, prior function, stroke type and severity indicators, and hospital variation).
Acute hospital services in Australia.
Patients with stroke and aphasia status recorded (n=11,613) were included in the study. 3122 (26.9%) had aphasia documented in clinical notes (aphasia 51% male; median age 78 years; no aphasia 58% male; median age 74 years).
Quality of care indicators aligned with national evidence-based guidelines. In-hospital outcomes included complications, level of independence, survival, and discharge destination.
Patients with aphasia were less likely to be assessed for mood impairment (23% versus 30%; aOR 0.73 95% CI 0.65, 0.81), receive risk factor education (59% versus 70%; aOR 0.55 95% CI 0.48, 0.64), or be involved in care plan development (83% versus 95%; aOR 0.22 95% CI 0.18, 0.28). Patients with aphasia were more likely to have a more severe stroke and had more in-hospital complications (aOR 1.46 95% CI 1.30, 1.63) and in-hospital deaths (aOR 2.86 95% CI 2.36, 3.49). They were less independent at discharge (aOR 0.48 95% CI 0.42, 0.56); less often discharged home (aOR 0.63 95% CI 0.56, 0.72); and more likely to be discharged to residential care (aOR 1.52 95% CI 1.08, 2.15). They were more likely to receive inpatient rehabilitation (aOR 1.15 95% CI 1.01, 1.30).
Important differences exist in the quality of acute stroke care received by patients with aphasia. Targeted quality improvement in mood screening and risk factor education is needed.
Observational cohort study of cross-sectional data from the biennial Stroke Foundation National Stroke Audit of Acute Services (2017, 2019 and 2021). Descriptive statistics and multivariable regression models were used to compare quality of care and in-hospital outcomes by aphasia status (care adjusted for hospital variation; outcomes adjusted for age, sex, prior function, stroke type and severity indicators, and hospital variation).
Acute hospital services in Australia.
Patients with stroke and aphasia status recorded (n=11,613) were included in the study. 3122 (26.9%) had aphasia documented in clinical notes (aphasia 51% male; median age 78 years; no aphasia 58% male; median age 74 years).
Quality of care indicators aligned with national evidence-based guidelines. In-hospital outcomes included complications, level of independence, survival, and discharge destination.
Patients with aphasia were less likely to be assessed for mood impairment (23% versus 30%; aOR 0.73 95% CI 0.65, 0.81), receive risk factor education (59% versus 70%; aOR 0.55 95% CI 0.48, 0.64), or be involved in care plan development (83% versus 95%; aOR 0.22 95% CI 0.18, 0.28). Patients with aphasia were more likely to have a more severe stroke and had more in-hospital complications (aOR 1.46 95% CI 1.30, 1.63) and in-hospital deaths (aOR 2.86 95% CI 2.36, 3.49). They were less independent at discharge (aOR 0.48 95% CI 0.42, 0.56); less often discharged home (aOR 0.63 95% CI 0.56, 0.72); and more likely to be discharged to residential care (aOR 1.52 95% CI 1.08, 2.15). They were more likely to receive inpatient rehabilitation (aOR 1.15 95% CI 1.01, 1.30).
Important differences exist in the quality of acute stroke care received by patients with aphasia. Targeted quality improvement in mood screening and risk factor education is needed.
Authors
Stone Stone, Wallace Wallace, Copland Copland, Cadilhac Cadilhac, Hill Hill, Purvis Purvis, Reyneke Reyneke, Kilkenny Kilkenny
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