Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study
Objectives There is uncertainty with respect to the hospital volume and clinical outcomes for patients with stroke. This study aimed to assess the association between hospital volume, processes of care and outcomes after ischaemic stroke.Design A multicentre prospective cohort study.Setting Two hund...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e060015.full |
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| author | Yongjun Wang Maigeng Zhou Gaifen Liu Yuesong Pan Runhua Zhang |
| author_facet | Yongjun Wang Maigeng Zhou Gaifen Liu Yuesong Pan Runhua Zhang |
| author_sort | Yongjun Wang |
| collection | DOAJ |
| description | Objectives There is uncertainty with respect to the hospital volume and clinical outcomes for patients with stroke. This study aimed to assess the association between hospital volume, processes of care and outcomes after ischaemic stroke.Design A multicentre prospective cohort study.Setting Two hundred and seventeen secondary or tertiary public hospitals from China.Participants A total of 17 550 patients within 7 days of acute ischaemic stroke were included.Main outcome measures The outcomes included all-cause mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. The patients were divided into four groups based on quartiles of the hospital volume. We compared the difference in the process of care across the groups and estimated the effects of hospital volume on mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. Restricted cubic splines were used to illustrate the association between hospital volume and clinical outcomes.Results There were no significant differences in the process of care across the four groups. When adjusted for confounders, the effect of hospital volume on mortality, recurrent stroke and combined vascular events was not significant. However, compared with the highest quartile, the patients in the lowest quartile of hospital volume tend to have poor outcome at 1 year (OR=1.29, 95% CI 1.01 to 1.64, p=0.0393). The restricted cubic spline analyses suggested a non-linear relationship between hospital volume and 1-year combined vascular events and poor outcome at 3 months and 1 year.Conclusions We found no significant associations between hospital volume, processes of care at the hospital, and mortality, recurrent stroke, and combined vascular events in patients with ischaemic stroke. However, hospital volume may be associated with poor outcome at 1 year. |
| format | Article |
| id | doaj-art-3c52387f43154ea7b52e88e2bc5a38c9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-3c52387f43154ea7b52e88e2bc5a38c92025-02-01T10:30:13ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-060015Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational studyYongjun Wang0Maigeng Zhou1Gaifen Liu2Yuesong Pan3Runhua Zhang4Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaNational Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Beijing, ChinaDepartment of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaObjectives There is uncertainty with respect to the hospital volume and clinical outcomes for patients with stroke. This study aimed to assess the association between hospital volume, processes of care and outcomes after ischaemic stroke.Design A multicentre prospective cohort study.Setting Two hundred and seventeen secondary or tertiary public hospitals from China.Participants A total of 17 550 patients within 7 days of acute ischaemic stroke were included.Main outcome measures The outcomes included all-cause mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. The patients were divided into four groups based on quartiles of the hospital volume. We compared the difference in the process of care across the groups and estimated the effects of hospital volume on mortality, poor outcome, recurrent stroke, and combined vascular events at 3 months and 1 year. Restricted cubic splines were used to illustrate the association between hospital volume and clinical outcomes.Results There were no significant differences in the process of care across the four groups. When adjusted for confounders, the effect of hospital volume on mortality, recurrent stroke and combined vascular events was not significant. However, compared with the highest quartile, the patients in the lowest quartile of hospital volume tend to have poor outcome at 1 year (OR=1.29, 95% CI 1.01 to 1.64, p=0.0393). The restricted cubic spline analyses suggested a non-linear relationship between hospital volume and 1-year combined vascular events and poor outcome at 3 months and 1 year.Conclusions We found no significant associations between hospital volume, processes of care at the hospital, and mortality, recurrent stroke, and combined vascular events in patients with ischaemic stroke. However, hospital volume may be associated with poor outcome at 1 year.https://bmjopen.bmj.com/content/12/6/e060015.full |
| spellingShingle | Yongjun Wang Maigeng Zhou Gaifen Liu Yuesong Pan Runhua Zhang Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study BMJ Open |
| title | Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study |
| title_full | Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study |
| title_fullStr | Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study |
| title_full_unstemmed | Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study |
| title_short | Association between hospital volume, processes of care and outcomes after acute ischaemic stroke: a prospective observational study |
| title_sort | association between hospital volume processes of care and outcomes after acute ischaemic stroke a prospective observational study |
| url | https://bmjopen.bmj.com/content/12/6/e060015.full |
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