Adherence to Clinical Guidelines Improves Patient Outcomes in Australian Audit of Stroke Rehabilitation Practice

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• 作者：Isobel J. Hubbard ; MOT^a ; ^{Isobel.Hubbard@newcastle.edu.au" class="auth_mail" title="E-mail the corresponding author} ; Dawn Harris^c ; Monique F. Kilkenny ; MPH^b ; Steven G. Faux ; MBBS ; FRACGP ; FAFRM^d ; Michael R. Pollack ; MBBS ; FAFRM ; FACRM ; FFPM ; MMedSci^a ; Dominique A. Cadilhac ; MPH ; PhD^b
• 关键词：Delivery of health care ; Stroke ; Rehabilitation
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2012
• 出版时间：June 2012
• 年：2012
• 卷：93
• 期：6
• 页码：965-971
• 全文大小：229 K

文摘

Hubbard IJ, Harris D, Kilkenny MF, Faux SG, Pollack MR, Cadilhac DA. Adherence to clinical guidelines improves patient outcomes in Australian audit of stroke rehabilitation practice.

Objective

To study the correlation between adherence to recommended management and good recovery outcomes in an Australian cohort of inpatients receiving rehabilitation.

Design

Processes of care were audited and included those recommended in the Australian Clinical Guidelines for Stroke Rehabilitation and Recovery.

Setting

National audit data from 68 rehabilitation units were used, with each hospital contributing up to 40 consecutive cases.

Participants

Not applicable.

Interventions

Not applicable.

Main Outcome Measures

Discharged home or an increase of greater than or equal to 22 in FIM scores between admission and discharge. Multivariable logistic regression models controlling for patient clustering were used to assess the associations between adherence to recommended management and recovery outcomes (dependent variables).

Results

Hospitals contributed 2119 patients (median age 75y, 53% men). We found that rehabilitation units providing evidence-based management (eg, treatment for sensorimotor impairment 38%, hypertonicity 56%, mobility 94%, and home assessments 71%) were more likely to provide better recovery outcomes for people with stroke. A discharge FIM score of 100 was clinically relevant and was strongly correlated with whether or not a patient was discharged home. We found very good correlation between admission and discharge FIM scores in stroke rehabilitation.

Conclusions

This is one of the first study comparing adherence to recommended management in Australian rehabilitation units and stroke recovery outcomes based on national audit data. Novel findings include the significance of an FIM score between 80 and 100 and the clinical significance of various management processes.