Automatic Screening Risk of Stroke-associated Pneumonia and Giving Feedback to Medical Staff Can Improve Outcomes and Save Healthcare Cost in Stroke Unit.
Shi Cheng, Junping Guo, Lin Lin, Jing Li, Wenyu Dong, Feifei Ma, Yanfang Li, Qixuan Guan, Wenrui Xing, Yanfang Liu, Runhua Zhang, Gaifen Liu, Jingjing Lu, Yi Ju, Xingquan Zhao, Yuewei Zhang, Ruijun Ji
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引用次数: 0
Abstract
Background: Stroke-associated pneumonia (SAP) is a major infectious complication after stroke and has adverse impact on clinical outcomes. This study investigates whether automatic screening the risk of SAP and giving feedback to medical staff would reduce the incidence of in-hospital pneumonia and improve clinical outcomes in patients with acute ischemic stroke (AIS).
Methods: This monocentric retrospective cohort study involved eligible inpatients in neurology department of Beijing Tiantan Hospital from June 2019 to October 2023. A quality improvement program was initiated on July 1, 2021, in which validated risk models was used to screen potential risk of SAP after stroke and feedback was automatically given to medical staff by electric medical records in real time. The primary outcome was occurrence of pneumonia during hospitalization. In addition, the following clinical outcomes were used including in-hospital urinary tract infection, length of stay (LOS), total medical cost during hospitalization, mRS score at discharge and in-hospital mortality. Multivariable logistic regression was performed to evaluate the association between the quality improvement program (after versus before) and clinical outcomes.
Results: A total number of 2,010 AIS patients were included with 652 patients in pre-implementation group and 1,358 patients in post-implementation group. It was shown that the quality improvement program was significantly associated with lower incidence of in-hospital pneumonia (adjusted OR=0.421, 95% CI=0.237-0.746, P=0.003) and better functional outcome (mRS≤2) (adjusted OR=1.332, 95% CI=1.003-1.769, P=0.048). In addition, it was illustrated that the program was significantly associated with shorter LOS (≤7days) (adjusted OR=3.914, 95% CI=2.865-5.347, P<0.001) and lower total healthcare cost during hospitalization (>15,000 CNY) (adjusted OR=0.479, 95% CI=0.392-0.586, P<0.001).
Conclusions: SAP risk screening and giving feedback to medical staff is an effective way to reduce in-hospital pneumonia, improve functional outcome and save healthcare cost after stroke.
期刊介绍：
A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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