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Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke

BACKGROUND: Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) fro...

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Autores principales: Mohammed, Mustapha, Zainal, Hadzliana, Tangiisuran, Balamurugan, Harun, Sabariah N., Ghadzi, Siti M., Looi, Irene, Sidek, Norsima N., Yee, Keng L., Aziz, Zariah A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Centro de Investigaciones y Publicaciones Farmaceuticas 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092711/
https://www.ncbi.nlm.nih.gov/pubmed/32256900
http://dx.doi.org/10.18549/PharmPract.2020.1.1760
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author Mohammed, Mustapha
Zainal, Hadzliana
Tangiisuran, Balamurugan
Harun, Sabariah N.
Ghadzi, Siti M.
Looi, Irene
Sidek, Norsima N.
Yee, Keng L.
Aziz, Zariah A.
author_facet Mohammed, Mustapha
Zainal, Hadzliana
Tangiisuran, Balamurugan
Harun, Sabariah N.
Ghadzi, Siti M.
Looi, Irene
Sidek, Norsima N.
Yee, Keng L.
Aziz, Zariah A.
author_sort Mohammed, Mustapha
collection PubMed
description BACKGROUND: Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored. OBJECTIVE: This study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke. METHODS: We included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients’ baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal. RESULTS: A total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05). CONCLUSIONS: KPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients.
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spelling pubmed-70927112020-04-01 Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke Mohammed, Mustapha Zainal, Hadzliana Tangiisuran, Balamurugan Harun, Sabariah N. Ghadzi, Siti M. Looi, Irene Sidek, Norsima N. Yee, Keng L. Aziz, Zariah A. Pharm Pract (Granada) Original Research BACKGROUND: Stroke is a leading cause of death worldwide. The cases of acute ischemic stroke are on the increase in the Asia Pacific, particularly in Malaysia. Various health organizations have recommended guidelines for managing ischemic stroke, but adherence to key performance indicators (KPI) from the guidelines and impact on patient outcomes, particularly mortality, are rarely explored. OBJECTIVE: This study aims to evaluate the impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke. METHODS: We included all first-ever ischemic stroke patients enrolled in the multiethnic Malaysian National Neurology Registry (NNeuR) - a prospective cohort study and followed-up for six months. Patients’ baseline clinical characteristics, risk factors, neurological findings, treatments, KPI and mortality outcome were evaluated. The KPI nonadherence (NAR) and relationship with mortality were evaluated. NAR>25% threshold was considered suboptimal. RESULTS: A total of 579 first-ever ischemic stroke patients were included in the final analysis. The overall mortality was recorded as 23 (4.0%) in six months, with a median (interquartile) age of 65 (20) years. Majority of the patients (dead or alive) had partial anterior circulation infarct, PACI (43.5%; 34.0%) and total anterior circulation infarct, TACI (26.1%; 8.8%). In addition, DVT prophylaxis (82.8%), anticoagulant for atrial fibrillation (AF) patients (48.8%) and rehabilitation (26.2%) were considered suboptimal. NAR < 2 was significantly associated with a decrease in mortality (odds ratio 0.16; 0.02-0.12) compared to NAR>2. Survival analysis showed that death is more likely in patients with NAR>2 (p=0.05). CONCLUSIONS: KPI nonadherence was associated with mortality among ischemic stroke patients. The adherence to the KPI was sub-optimal, particularly in DVT prophylaxis, anticoagulant for AF patients and rehabilitation. These findings reflect the importance of continuous quality measurement and implementation of evidence recommendations in healthcare delivery to achieve optimal outcome among stroke patients. Centro de Investigaciones y Publicaciones Farmaceuticas 2020 2020-03-09 /pmc/articles/PMC7092711/ /pubmed/32256900 http://dx.doi.org/10.18549/PharmPract.2020.1.1760 Text en Copyright: © Pharmacy Practice http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Mohammed, Mustapha
Zainal, Hadzliana
Tangiisuran, Balamurugan
Harun, Sabariah N.
Ghadzi, Siti M.
Looi, Irene
Sidek, Norsima N.
Yee, Keng L.
Aziz, Zariah A.
Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title_full Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title_fullStr Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title_full_unstemmed Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title_short Impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
title_sort impact of adherence to key performance indicators on mortality among patients managed for ischemic stroke
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092711/
https://www.ncbi.nlm.nih.gov/pubmed/32256900
http://dx.doi.org/10.18549/PharmPract.2020.1.1760
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