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Processes of stroke unit care and outcomes at discharge in Vietnam: findings from the Registry of Stroke Care Quality (RES-Q) in a major public hospital

Citation

Nguyen, TH and Gall, S and Cadilhac, DA and Nguyen, H and Terry, D and Pham, BN and Nguyen, TQ and Nguyen, AT and Dao, NT and Duong, CD and Phan, BV and Phan, HT, Processes of stroke unit care and outcomes at discharge in Vietnam: findings from the Registry of Stroke Care Quality (RES-Q) in a major public hospital, Journal of Stroke Medicine pp. 1-9. ISSN 2516-6085 (2019) [Refereed Article]


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Copyright Statement

© 2019 Indian Stroke Association

DOI: doi:10.1177/2516608519869132

Abstract

Background: An essential strategy to reduce mortality and disability after stroke is to ensure access to evidence-based care. In developed countries, it has been shown that if hospitals improve the quality of care, the impact of stroke is attenuated. However, in developing countries, data on the processes of care and associated patient outcomes are scarce. We examined the care processes and outcomes among patients with acute stroke from a stroke unit in a major public hospital in Vietnam whereby there are approximately 15,000 hospital admissions for stroke per year.

Methods: We included first-ever strokes admitted to the 115 People’s Hospital (June 2017-March 2018). Data were collected in the Registry of Stroke Care Quality which is used in >50 countries. Baseline characteristics, stroke-related factors (e.g., type and severity), processes of care (e.g., thrombolysis), and outcomes at discharge were examined including mortality and functional outcome, assessed as the walking ability without assistance.

Results: Data were available for 6601 patients with first-ever stroke (44% women, 80% ischemic stroke [IS], median age: 62 years, interquartile range [IQR]: 53-72) who received stroke unit care. The median time from stroke onset to hospital arrival was 15.7 hours (IQR: 5.6-37.5). At admission, the median National Institute of Health Stroke Scale score indicating stroke severity was 7 (IQR: 4-12). Among those with IS, 9% received intravenous thrombolysis. Over 90% of the participants received recommended process of care including dysphasia screening (99%), antihypertensive agents (92%), cholesterol-lowering medication (IS = 99%), and antithrombotic medication (IS = 98%). At discharge (median length of stay: 4 days, IQR: 3-6), 3% of all cases died and 46% were able to walk independently. Advanced age, stroke severity, and not receiving antihypertensive agent(s) were contributing factors to mortality and poorer functional outcome.

Conclusion: There was a considerable delay in the time from stroke onset to hospital arrival. Evidence-based care at the stroke unit was consistently provided. It remains unclear whether other hospitals in Vietnam and other developing countries perform as well. Greater public awareness of stroke to reduce onset to arrival times and more stroke units are warranted to achieve the excellent outcomes in the major public hospital.

Item Details

Item Type:Refereed Article
Keywords:processes of care, ischemic stroke, intracerebral hemorrhage
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Gall, S (Associate Professor Seana Gall)
UTAS Author:Nguyen, H (Dr Hoang Nguyen)
UTAS Author:Phan, HT (Miss Hoang Phan)
ID Code:135599
Year Published:2019
Deposited By:Wicking Dementia Research and Education Centre
Deposited On:2019-11-05
Last Modified:2019-12-04
Downloads:3 View Download Statistics

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