Demographic and stroke-related factors as predictors of quality of acute stroke care provided by allied health professionals

Figures & data

Table 2 Eligibility for process indicator care, care adherence and association with age

Process indicator	Patients eligible for process indicator		Process indicator adherence for those eligible		Process indicator adherence by age <75 vs ≥75 yrs
	N	%	N	%	Odds ratio (95% confidence interval)
1. Swallow screening	279	(93)	144	(51.6)	1.02 (0.63–1.66)
2. PT assessment (<48 hours of admission)	275	(91.7)	167	(60.7)	0.99 (0.60–1.63)
3. OT assessment (<48 hours of admission)	275	(91.7)	97	(35.3)	0.79 (0.47–1.33)
4. SP assessment (<48 hours of admission)	275	(91.7)	174	(63.3)	1.08 (0.65–1.80)
5. DN assessment (<48 hours of admission)	274	(91.3)	24	(8.8)	0.98 (0.41–2.32)
6. SW assessment (<7 days of admission)	277	(92.3)	71	(25.6)	0.93 (0.53–1.62)
7. Cognitive assessment	244	(81.3)	47	(19.3)	1.5929 (0.84–3.02)
8. First mobilization <24 hours of stroke onset	211	(70.3)	25	(11.8)	2.39 (1.03 5.56)**
9. Early PT rehabilitation (<48 hours of admission)	195	(65.0)	20	(10.2)	1.73 (0.68–4.39)
10. Early SP rehabilitation (<48 hours of admission)	168	(56.0)	2	(1.2)	# (NA for small numbers)
11. Early OT rehabilitation (<48 hours of admission)	205	(68.3)	3	(1.5)	#
12. NGT process	42	(14.0)	41	(97.6)	#
13. Nutritional screen	193	(64.3)	0	(0)	#
14. Mood assessment	224	(74.6)	1	(0.5)	#
15. Family meeting	292	(97.3)	34	(11.6)	0.47 (0.20–1.08)
16. Stroke education	273	(91.0)	33*	(12.1)	1.8 (0.88–3.81)
17. Secondary stroke prevention	207	(69.0)	17	(8.2)	#
18. Home visit	49	(16.3)	2	(5.0)	#
19. Carer skills training	39	(13.0)	1	(2.6)	#
20. Discharge plan provided	131	(43.7)	12	(9.2)	#

Notes:

* Missing data for one patient;

** Significant correlation found;

#, NA for small numbers (less than 5 in one cell).

Abbreviations: PT, Physiotherapy; OT, Occupational therapy; SP, Speech pathology; SW, social work; DN, Dietetics.

Definitions: First mobilization, documentation of patient first sitting out of bed or ambulating with or without assistance; Rehabilitation, therapeutic interventions to retrain neurological deficits or teach compensatory techniques aimed at improving function (excludes assessment). NGT process, Naso-gastric tube feeding if no functional swallow during the first month post stroke; Home visit, environmental assessment by OT or PT to facilitate discharge to home (with/without patient present).

Figure 1 Simple causal pathway of variables associated with a patient journey following acute stroke.

Table 1 Patients characteristics (n = 300)

Patient characteristics	No.	(%)
Gender
Male	159	(53)
Female	141	(47)
Age group (years)
<65	62	(20.6)
65–74	50	(16.7)
75–84	123	(41.0)
85+	65	(21.7)
Comorbidities (CCI)
≤1 (low level)	91	(30.3)
>1 (high level)	208	(69.3)
Missing data	1
Pre-morbid residential care	35	(11.7)
Pre-morbid independence	208	(69.3)
Not proficient in English (%)	24	(8.0)
Stroke severity (NIHSS)
<8 (mild)	158	(52.7)
8–16 (moderate)	93	(31.0)
>16 (severe)	49	(16.3)
Weekend admission	101	(33.7)
Stroke unit admission	146	(48.7)
Not applicable (eg, died in emergency)	7	(2.0)
Missing data	2
Length of stay (days)
<4	68	(22.7)
4–9	116	(38.7)
10+	116	(38.7)
Died during admission	64	(21.3)

Table 3 Univariate model of independent variables (excluding age) and adherence to process indicators

Process indicator	Independent variables-excluding age. Odds ratios (95% CIs)
	Stroke severity	Day of admission	CCI	Gender	LOS^	English	Dependence	Accomm	Stroke unit
Comparitor	NIHSS < 8	Weekday	CCI ≤ 1	Female	<12 days	Proficient	Independent	Residential care	Stroke unit bed
1. Swallow screening	0.37 (0.23–0.61)	3.09 (1.84–5.22)	1.29 (0.77–2.15)	0.75 (0.47–1.21)	0.50 (0.30–0.82)	1.31 (0.54–3.13)	0.90 (0.54–1.49)	1.52 (0.73–3.17)	0.99 (0.62–1.60)
2. PT assessment	0.74 (0.45–1.22)	2.32 (1.39–3.87)	1.58 (0.92–2.71)	0.91 (0.56–1.48)	0.82 (0.50–1.37)	0.46 (0.16–1.29)	0.87 (0.51–1.49)	1.76 (0.83–3.73)	1.21 (0.74–1.98)
3. OT assessment	1.0 (0.61–1.64)	1.49 (0.87–2.55)	1.47 (0.87–2.50)	0.93 (0.56–1.52)	0.76 (0.45–1.26)	0.88 (0.35–2.19)	1.13 (0.65–1.95)	2.0 (0.83–4.84)	0.81 (0.49–1.32)
4. SP assessment	0.29 (0.17–0.49)	1.89 (1.13–3.16)	1.19 (0.69–2.03)	0.60 (0.36–0.99)	0.41 (0.24–0.71)	0.91 (0.37–2.23)	0.96 (0.56–1.65)	0.94 (0.43–2.05)	0.72 (0.44–1.19)
5. DN assessment	0.17 (0.06–0.48)	2.10 (0.76–5.82)	1.14 (0.47–2.77)	0.48 (0.20–1.14)	0.30 (0.13–0.73)	#	0.67 (0.28–1.61)	0.60 (0.19–1.90)	1.26 (0.54–2.94)
6. SW assessment	0.69 (0.40–1.20)	1.10 (0.62–1.95)	1.08 (0.60–1.93)	0.64 (0.37–1.09)	0.40 (0.23–0.69)	0.50 (0.21–1.22)	0.82 (0.46–1.46)	2.53 (0.85–7.49)	1.15 (0.67–1.98)
7. Cognitive assessment	0.89 (0.46–1.70)	0.81 (0.42–1.57)	1.31 (0.67–2.55)	0.92 (0.48–1.74)	0.61 (0.32–1.17)	#	3.77 (1.42–9.99)	#	1.06 (0.56–2.03)
8. Early mobilization	3.08 (1.11–8.57)	1.45 (0.57–3.64)	1.47 (0.60–3.55)	1.14 (0.49–2.65)	#	#	1.58 (0.60–4.16)	#	1.52 (0.65–3.55)
9. PT rehabilitation	1.67 (0.64–4.40)	1.42 (0.49–4.08)	3.30 (1.29–8.47)	3.18 (1.11–9.12)	2.25 (0.83–6.14)	#	1.56 (0.42–3.16)	#	2.96 (1.03–8.51)
10. SP rehabilitation	#	#	#	#	#	#	#	#	#
11. OT rehabilitation	#	#	#	#	#	#	#	#	#
12. NGT process	#	#	#	#	#	#	#	#	#
13. Nutritional screen	#	#	#	#	#	#	#	#	#
14. Mood assessment	#	#	#	#	#	#	#	#	#
15. Family meeting	0.13 (0.05–0.34)	1.80 (0.78–4.14)	1.73 (0.83–3.61)	0.68 (0.33–1.39)	0.17 (0.08–0.37)	0.46 (0.16–1.33)	1.04 (0.47–2.28)	#	2.33 (1.06–5.11)
16. Stroke education	0.37 (0.17–0.81)	0.89 (0.42–1.90)	1.05 (0.49–2.28)	1.66 (0.78–3.53)	1.65 (0.71–3.82)	#	1.50 (0.62–3.61)	#	1.12 (0.53–2.39)
17. Secondary prevention	#	0.93 (0.33–2.63)	2.86 (1.04–7.86)	#	#	#	#	#	#
18. Home visit	#	#	#	#	#	#	#	#	#
19. Carer skills training	#	#	#	#	#	#	#	#	#
20. Discharge plan	0.18 (0.05–0.65)	#	#	#	0.37 (0.11–1.27)	#	#	#	#

Notes: Highlight, significant correlation found;

#, insufficient data (less than 5 in one cell);

^, LOS < 12 days versus LOS ≥ 12 days.

Abbreviations: PT, physiotherapy; OT, occupational therapy; SP, speech pathology; DN, dietitian; SW, social worker; NGT, naso-gastric tube; LOS, length of stay; Accomm, pre-morbid accommodation; Dependence, pre-morbid level of independence; English, English proficiency; Stroke Unit, admitted directly to a stroke unit.

Appendix 1 Correlations between age and other predictor variables

	Patients age <75 years compare to patients ≥75 years
	Odds ratios (95% confidence interval)	Test finding
NIHSS <8 (mild stroke)	#	##
NIHSS 8–16 (moderate-to-severe stroke)	1.8 (1.1–3.2)**	Older group significantly more likely to have had a moderate-to-severe stroke or very severe stroke than younger group
NIHSS >16 (very severe stroke)	2.9 (1.4–6.1)**
Charlson comorbidity index	2.5 (1.5–4.2)**	Older group significantly more likely to have higher comorbidity levels than younger group
Previous accommodation	2.6 (1.1–6.2)**	Older group significantly more likely to live in residential care pre-morbidly, than younger group
Previous independence	6.2 (3.2–12)**	Older group significantly more likely to have been dependent pre-morbidly, than younger group
Admitted to stroke unit bed	1.7 (0.8–3.6)	No correlation
Weekend admission	0.9 (0.6–1.5)	No correlation
Gender	2.2 (1.4–3.6)**	Females significantly more likely to be in the older group than males
English proficiency	3.2 (1.1–9.7)**	Older group significantly more likely to have poor English proficiency
LOS ≤4 days	#	##
LOS 5–9 days	0.6 (0.3–0.9)**	Older group significantly less likely to have LOS of 5–10 days than the younger group
LOS ≥ 10 days	1.7 (0.9–3.2)	Trend for older group to be more likely to have LOS > 10 days than the younger group

Notes:

** Statistically significant;

#, Sub-group used as comparator in analysis (odds ratio = 1).

Abbreviations: LOS, length of stay; NIHSS, National Institute of Health Stroke Scale.

Figure 2 Confounding relationships between non-age variables.

Abbreviations: CCI, Charlson Comorbidity Index; LOS, length of stay.

Appendix 2 Matrix of non-age variables

Odds ratios (95% confidence intervals)
	Comparator	Stroke severity	CCI	Gender	Accom	Dependence	Stroke unit	Weekend admission	English
Stroke severity	Mild stroke (NIHSS < 8)
CCI	High level comorbidity	0.6 (0.4–0.98)*
Gender	Female	0.4 (0.2–0.6)*	1.1 (0.7–1.8)
Accommodation	Nursing home, hostel	0.3 (0.1–0.7)*	8.3 (2.0–35.6)*	1.8 (0.9–3.7)
Dependence	Dependent	0.6 (0.4–1.0)	4.1 (2.1–8.0)*	2.2 (1.4–3.7)*	#
Stroke unit	Not stroke unit	0.7 (0.5–1.2)	1.9 (0.9–4.2)	1.1 (0.6–2.1)	8.5 (3.0–24.3)*	5.5 (2.7–11.3)*
Weekend admission	Weekend	1.0 (0.6–1.6)	1.1 (0.6–1.9)	1.0 (0.6–1.6)	1.2 (0.6–2.5)	0.9 (0.5–1.5)	1.7 (0.9–3.4)
English	Not proficiency	0.4 (0.2–0.9)	0.9 (0.3–2.1)	0.9 (0.4–2.2)	0.7 (0.1–3.0)	2.9 (1.3–6.9)*	0.6 (0.2–1.4)	1.2 (0.5–2.8)
LOS 5–9 days	LOS ≤ 4 days	0.9 (0.5–1.7)	0.9 (0.5–1.7)	0.8 (0.5–1.5)	1.2 (0.5–2.6)	1.1 (0.6–2.1)	1.0 (0.4–2.2)	0.4 (0.2–0.8)*	0.3 (0.1–1.2)
LOS > 10 days		2.6 (1.5–4.7)*	0.6 (0.3–1.2)	0.4 (0.2–0.7)*	2.5 (1.0–6.5)	0.8 (0.4–1.5)	1.4 (0.6–3.4)	0.6 (0.3–1.0)	0.3 (0.1–1.1)

Notes:

* Significant correlation found;

#, Numbers in one cell too small to calculate. An odds ratio of 1 is used as comparator in analysis.

Abbreviations: LOS, length of stay; accom, pre-morbid accommodation; dependence, pre-morbid level of independence; stroke unit, admitted directly to a stroke unit; CCI, Charleson Comorbidity Index; NIHSS, National Institute of Health Stroke Scale.

Figure 3 Relationships between variables for the patient journey with acute stroke.

Abbreviation: PI, process indicator.