Adherence to ambulance performance indicators and patient outcomes after stroke: An Australian data linkage study.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Australasian Emergency Care Pub Date : 2025-07-04 DOI:10.1016/j.auec.2025.04.002

Amminadab L Eliakundu, Joosup Kim, Karen Smith, Monique F Kilkenny, Mulugeta M Birhanu, Kathleen L Bagot, Emily Nehme, Shelley Cox, Bruce C V Campbell, Ben Clissold, Helen M Dewey, Jodie Rabaut, Henry Ma, Christopher F Bladin, Dominique A Cadilhac

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引用次数: 0

Abstract

Background: The impact of Emergency Medical Service (EMS) stroke performance indicators on patient outcomes is unclear. We aimed to evaluate adherence to EMS indicators (15 minutes response, 60 minutes transport to a stroke centre or both) and associations with treatment access and patient outcomes.

Method: Retrospective cohort study using data from the Australian Stroke Clinical Registry and ambulance records from Victoria (2015-2017) for patients (≥18 years) with stroke transported by ambulance. Multivariable regression models were used to evaluate EMS adherence to performance indicators and outcomes of interest.

Results: Among 4206 patients (72 years; 42 % female), EMS indicators were less frequently met for patients in regional areas (aOR: 0.27; 95 % CI: 0.17, 0.43). Socio-economic disparities were observed, with patients in advantaged areas less likely to receive an ambulance response within 15 minutes. Adherence to EMS performance indicators was associated with shorter off-stretcher time and increased thrombolytic therapy use (aOR: 1.62; 95 % CI: 1.24, 2.11). EMS adherence to performance indicators did not significantly impact functional independence, or health-related quality of life.

Conclusions: EMS adherence to performance indicators improved off-stretcher time and thrombolytic therapy use but was influenced by geographic and socio-economic status. Refining EMS performance targets and tailoring public and EMS education on stroke is needed.

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坚持救护车性能指标和中风后患者的结果：澳大利亚的数据链接研究。

背景：急诊医疗服务（EMS）卒中表现指标对患者预后的影响尚不清楚。我们的目的是评估EMS指标的依从性（15分钟反应，60分钟转移到卒中中心或两者兼有）以及与治疗可及性和患者预后的关系。方法：回顾性队列研究，使用澳大利亚卒中临床登记处和维多利亚州救护车记录（2015-2017）的数据，对救护车运送的卒中患者（≥18岁）进行研究。使用多变量回归模型来评估EMS对绩效指标和相关结果的依从性。结果：4206例患者(72岁；42 %女性)，区域患者的EMS指标达到的频率较低(aOR: 0.27；95 % ci: 0.17, 0.43)。观察到社会经济差异，优势地区的患者不太可能在15分钟内收到救护车响应。遵守EMS绩效指标与较短的下担架时间和增加的溶栓治疗使用相关(aOR: 1.62；95 % ci: 1.24, 2.11)。EMS对绩效指标的依从性没有显著影响功能独立性或与健康相关的生活质量。结论：EMS对绩效指标的依从性提高了下担架时间和溶栓治疗的使用，但受地理和社会经济地位的影响。需要完善医疗服务的绩效目标，并针对中风进行针对性的公共和医疗服务教育。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Australasian Emergency Care Nursing-Emergency Nursing

CiteScore

3.30

自引率

5.60%

发文量

审稿时长

37 days

期刊介绍： Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.