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Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative

OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate antic...

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Autores principales: Wong, Kam Ying, Davies, Bethan, Adeleke, Yewande, Woodcock, Thomas, Matthew, Dionne, Sekelj, Sara, Orlowski, Andi, Porter, Bradley, Hashmy, Sophia, Mathew, Ammu, Grant, Ron, Kaba, Agnes, Unger-Graeber, Brigitte, Petrungaro, Bruno, Wallace, Jordan, Bell, Derek, Cowie, Martin R, Khan, Sadia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925241/
https://www.ncbi.nlm.nih.gov/pubmed/33649153
http://dx.doi.org/10.1136/openhrt-2020-001558
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author Wong, Kam Ying
Davies, Bethan
Adeleke, Yewande
Woodcock, Thomas
Matthew, Dionne
Sekelj, Sara
Orlowski, Andi
Porter, Bradley
Hashmy, Sophia
Mathew, Ammu
Grant, Ron
Kaba, Agnes
Unger-Graeber, Brigitte
Petrungaro, Bruno
Wallace, Jordan
Bell, Derek
Cowie, Martin R
Khan, Sadia
author_facet Wong, Kam Ying
Davies, Bethan
Adeleke, Yewande
Woodcock, Thomas
Matthew, Dionne
Sekelj, Sara
Orlowski, Andi
Porter, Bradley
Hashmy, Sophia
Mathew, Ammu
Grant, Ron
Kaba, Agnes
Unger-Graeber, Brigitte
Petrungaro, Bruno
Wallace, Jordan
Bell, Derek
Cowie, Martin R
Khan, Sadia
author_sort Wong, Kam Ying
collection PubMed
description OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative. METHODS: Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014. RESULTS: There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant. CONCLUSION: Reduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events.
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spelling pubmed-79252412021-03-19 Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative Wong, Kam Ying Davies, Bethan Adeleke, Yewande Woodcock, Thomas Matthew, Dionne Sekelj, Sara Orlowski, Andi Porter, Bradley Hashmy, Sophia Mathew, Ammu Grant, Ron Kaba, Agnes Unger-Graeber, Brigitte Petrungaro, Bruno Wallace, Jordan Bell, Derek Cowie, Martin R Khan, Sadia Open Heart Basic and Translational Research OBJECTIVE: Atrial fibrillation (AF) is the most common arrhythmia. Undiagnosed and poorly managed AF increases risk of stroke. The Hounslow AF quality improvement (QI) initiative was associated with improved quality of care for patients with AF through increased detection of AF and appropriate anticoagulation. This study aimed to evaluate whether there has been a change in stroke and bleeding rates in the Hounslow population following the QI initiative. METHODS: Using hospital admissions data from January 2011 to August 2018, interrupted time series analysis was performed to investigate the changes in standardised rates of admission with stroke and bleeding, following the start of the QI initiative in October 2014. RESULTS: There was a 17% decrease in the rate of admission with stroke as primary diagnosis (incidence rate ratio (IRR) 0.83; 95% CI 0.712 to 0.963; p<0.014). There was an even larger yet not statistically significant decrease in admission with stroke as primary diagnosis and AF as secondary diagnosis (IRR 0.75; 95% CI 0.550 to 1.025; p<0.071). No significant changes were observed in bleeding admissions. For each outcome, an additional regression model including both the level change and an interaction term for slope change was created. In all cases, the slope change was small and not statistically significant. CONCLUSION: Reduction in stroke admissions may be associated with the AF QI initiative. However, the immediate level change and non-significant slope change suggests a lack of effect of the intervention over time and that the decrease observed may be attributable to other events. BMJ Publishing Group 2021-03-01 /pmc/articles/PMC7925241/ /pubmed/33649153 http://dx.doi.org/10.1136/openhrt-2020-001558 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Basic and Translational Research
Wong, Kam Ying
Davies, Bethan
Adeleke, Yewande
Woodcock, Thomas
Matthew, Dionne
Sekelj, Sara
Orlowski, Andi
Porter, Bradley
Hashmy, Sophia
Mathew, Ammu
Grant, Ron
Kaba, Agnes
Unger-Graeber, Brigitte
Petrungaro, Bruno
Wallace, Jordan
Bell, Derek
Cowie, Martin R
Khan, Sadia
Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title_full Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title_fullStr Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title_full_unstemmed Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title_short Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
title_sort hospital admissions for stroke and bleeding in hounslow following a quality improvement initiative
topic Basic and Translational Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925241/
https://www.ncbi.nlm.nih.gov/pubmed/33649153
http://dx.doi.org/10.1136/openhrt-2020-001558
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