EFFECTS OF A SPECIALIZED TEAM ON STROKE CARE - THE FIRST 2 YEARS OF THE YALE STROKE PROGRAM

被引:65
作者
WEBB, DJ
FAYAD, PB
WILBUR, C
THOMAS, A
BRASS, LM
机构
[1] YALE UNIV,SCH MED,DEPT NEUROL,YALE STROKE PROGRAM,NEW HAVEN,CT 06510
[2] DEPT VET AFFAIRS MED CTR,NEUROL SERV,W HAVEN,CT
关键词
CEREBRAL INFARCTION; COMPLICATIONS; HOSPITALIZATION; STROKE MANAGEMENT;
D O I
10.1161/01.STR.26.8.1353
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose Strategies have been proposed for stroke care to improve quality or reduce cost. We sought to document the effects of a new program of specialized stroke care. Methods In a programmatic review using historical and concurrent control subjects, we evaluated patients discharged with a stroke diagnosis (diagnosis-related group 14) over a B-year period between January 1987 and December 1992. Patients were from an academic medical center. The intervention was consultation (on university neurology patients) by a specialized multidisciplinary team during the last 2 years of the review period. The main outcome measures were median length of stay and rate of common complications before and after implementation compared with other hospital services (private neurology and medicine). Results Stroke team involvement was associated with a shortened median length of stay from 10 to 8 days (P < .0001). There was no significant change in the median length of stay for the private neurology or medicine services. After stroke team involvement, there were fewer urinary tract infections (P = .056), and those patients who developed infection had a shorter length of stay (P = .0007). There was no change in the rate of aspiration pneumonia or in length of stay for patients with aspiration pneumonia. Mortality did not change. Conclusions A coordinated, multidisciplinary approach to stroke care may reduce length of stay and morbidity in patients hospitalized because of stroke.
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收藏
页码:1353 / 1357
页数:5
相关论文
共 23 条
[11]   STROKE INTENSIVE CARE - AN APPRAISAL [J].
KENNEDY, FB ;
POZEN, TJ ;
GABELMAN, EH ;
TUTHILL, JE ;
ZAENTZ, SD .
AMERICAN HEART JOURNAL, 1970, 80 (02) :188-&
[12]   A METHODOLOGICAL APPRAISAL OF RESEARCH ON PROGNOSIS AFTER TRANSIENT ISCHEMIC ATTACKS [J].
KERNAN, WN ;
FEINSTEIN, AR ;
BRASS, LM .
STROKE, 1991, 22 (09) :1108-1116
[13]   A PROGNOSTIC SYSTEM FOR TRANSIENT ISCHEMIA OR MINOR STROKE [J].
KERNAN, WN ;
HORWITZ, RI ;
BRASS, LM ;
VISCOLI, CM ;
TAYLOR, KJW .
ANNALS OF INTERNAL MEDICINE, 1991, 114 (07) :552-557
[14]   LACUNAR VERSUS NON-LACUNAR INFARCTS - PATHOGENETIC AND PROGNOSTIC DIFFERENCES [J].
LANDI, G ;
CELLA, E ;
BOCCARDI, E ;
MUSICCO, M .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1992, 55 (06) :441-445
[15]   DO STROKE UNITS SAVE LIVES [J].
LANGHORNE, P ;
WILLIAMS, BO ;
GILCHRIST, W ;
HOWIE, K .
LANCET, 1993, 342 (8868) :395-398
[16]  
MCGOVERN PG, 1992, JAMA-J AM MED ASSOC, V266, P753
[17]  
MULLEY G, 1978, BRIT MED J, V2, P1321, DOI 10.1136/bmj.2.6148.1321
[18]   STROKE UNITS OR STROKE CENTERS [J].
NORRIS, JW ;
HACHINSKI, VC .
STROKE, 1986, 17 (03) :360-362
[19]   INTENSIVE-CARE MANAGEMENT OF STROKE PATIENTS [J].
NORRIS, JW ;
HACHINSKI, VC .
STROKE, 1976, 7 (06) :573-577
[20]   COMPLICATIONS OF ACUTE STROKE [J].
OPPENHEIMER, S ;
HACHINSKI, V .
LANCET, 1992, 339 (8795) :721-724