GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Online Resource
    Online Resource
    Specialized Outpatient Clinic vs Stroke Unit for TIA and Minor Stroke : A Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Neurology Vol. 96, No. 8 ( 2021-02-23), p. e1096-e1109
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 96, No. 8 ( 2021-02-23), p. e1096-e1109
    Abstract: To evaluate the effects of an outpatient clinic setup for minor stroke/TIA using subsequent admission of patients at high risk of recurrent stroke. Methods We performed a cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Patients with stroke were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on nonprioritized outcomes: length of stay, readmissions, care quality (10 process–performance measures), and mortality. Patients with TIA were compared to contemporary matched, hospitalized controls. Following complete diagnostic workup, patients with stroke/TIA were classified into low/high risk of recurrent stroke ≤7 days. Results We analyzed 1,076 consecutive patients, of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the patients with stroke were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n = 191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days; adjusted length of stay ratio 0.49; 95% confidence interval 0.33–0.71). Thirty-day readmission rate was 3.2% vs 11.6% (adjusted hazard ratio 0.23 [0.09–0.59]), and care quality was higher, with a risk ratio of 1.30 (1.15–1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the low risk category and not admitted experienced stroke within 7 days (0.6%). Conclusions An outpatient clinic setup for patients with minor stroke/TIA yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units. Classification of Evidence This study provides Class III evidence that a neurovascular specialist–driven outpatient clinic for patients with minor stroke/TIA with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000011453
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Abstract WP341: Is it Safe to Treat Patients With Acute Minor Stroke and Tia as Outpatients?
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Objective: To evaluate the effects of an acute 7-day outpatient clinic for minor stroke or transient ischemic attack (TIA). Methods: We performed a prospective cohort-study using all patients from an outpatient clinic for patient with suspected minor stroke and TIA between September 2013 and August 2014. The clinic opened in May 2012 as part of centralization of the stroke services in Central Region Denmark. For comparison, we used a matched historic cohort from the same hospital between May 2011 and April 2012 (before the outpatient clinic) and a contemporary cohort from a comparable university hospital from the Capital Region without an outpatient clinic. A risk-assessment tool was used in the outpatient clinic to determine the risk of recurrent stroke and hence a need for a hospital admission. Results: The outpatient clinic cohort (OCC) consisted of 1076 patients and we confirmed a neurovascular diagnosis in 510 of the patients (47.4%). Of these, 215 had a stroke and 94 (43.7%) were discharged direct from the outpatient clinic. TIA was confirmed in 171 patients and of these 121 (70.8%) were handled without a hospitalization. In the stroke patients from the OCC there was a shorter length of acute hospital stay (median 1 day) compared to the matched historic cohort (median 3 days); adjusted length of stay ratio of 0.49 (0.33-0.71). Furthermore these stroke patients had a 30-day readmission rate on 3.2 % (0.6-5.7) compared to 11.6 % (6.99-16.2) in the historic cohort; adjusted hazard ratio of 0.23 (0.09-0.59) and increased quality of care captured in 10 process performance measures. We found similar results in comparison with the contemporary cohort. Furthermore, we saw a similar pattern when we compared TIA patients from the OCC to a matched contemporary cohort. According to the risk-assessment, 170 stroke or TIA patients had a ‘low risk’ and were treated without being admitted as inpatients. Only one of these patients experienced a stroke within 7 days (0.59%). Conclusions: Overall, the results showed the outpatient set up for minor stroke and TIA was safe and may be an advance compared to hospitalization in stroke units despite use of less bed days. Furthermore, the risk assessment used to select patients in need of an inpatient course seems useful.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP341
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Effects of centralizing acute stroke services : A prospective cohort study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Neurology Vol. 91, No. 3 ( 2018-07-17), p. e236-e248
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 91, No. 3 ( 2018-07-17), p. e236-e248
    Abstract: To investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR). Methods The CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective “before-and-after” cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach. The population comprised 22,141 stroke cases hospitalized from May 2011 to April 2012 and May 2013 to April 2014. Results Centralization was associated with a significant reduction in length of acute hospital stay from a median of 5 to 2 days with a length-of-stay ratio of 0.53 (95% confidence interval 0.38–0.75, data adjusted) with no corresponding change seen in the rest of Denmark. Similarly, centralization led to a significant increase in strokes with same-day admission (mainly outpatients), whereas this remained unchanged in the rest of Denmark. We observed a significant improvement in quality of care captured in 11 process performance measures in both the CDR and the rest of Denmark. Centralization was associated with a nonsignificant increase in thrombolysis rate. We observed a slight increase in readmissions at day 30, but this was not significantly different from the general trend. Mortality at days 30 and 365 remained unchanged, as in the rest of Denmark. Conclusions Centralizing acute stroke care in the CDR significantly reduced the length of acute hospital stay without compromising quality. Readmissions and mortality stayed comparable to the rest of Denmark.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000005822
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract 87: Centralization of Acute Stroke Treatment was Associated With a Reduction in Length of Acute Hospital Stay
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: In 2012 a centralization and specialization of stroke services was implemented in Central Region Denmark (CRD) (n= 1.3 million inhabitants). It implied that acute stroke care was to be provided at only 2 units with re-vascularization therapy. Objective: The impacts on length of acute hospital stay (AHS), rate of thrombolysis (IV tPA), evidence-based clinical care and mortality. Methods: Population-based before-and-after registry study. The study cohort included all stroke cases in Denmark, with patients outside CRD being used as comparison to account for general changes in stroke care. The period before (May 2011- April 2012) was compared to after (May 2013 - April 2014) using regression methods, including difference-in-differences (DID) analysis. Potential confounders included age, gender, civil status, previous strokes, diabetes, atrial fibrillation, smoking, alcohol, stroke severity, hypertension and type of stroke. Results: Baseline data in Figure 1. Median length of AHS (days) in CRD decreased from 5 (IQR 7) to 2 (3) vs. from 5 (9) to 5 (8) in the rest of Denmark. IV tPA rates increased from 16% (95CI 14-17) to 19% (17-21) of all acute ischemic strokes in CRD and from 9% (8-10) to 14% (13-15) in the rest of Denmark (DID RR 0.77 (0.66-0.91)). All-or-none rates of 11 process performance measures of in-hospital care increased from 51% (49-53) to 63% (61-65) in CRD vs. 49% (48-50) to 60% (59-61) in the rest of Denmark (DID RR 0.99 (0.93-1.05)). Adjusted 30-days mortality rate decreased non-significantly and comparable to the rest of the country; OR 0.97 (0.71-1.32) vs. OR 0.91 (0.77-1.07) (DID OR 1.03 (0.75-1.41)). Conclusions: Centralization of acute stroke care was associated with a significant reduction in length of AHS when compared to the development in the rest of Denmark. The use of IV tPA and the quality of acute stroke care also improved, but the trend was not different from the rest of Denmark. No changes in the adjusted 30-days mortality were observed.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.87
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...