返回Google圖書搜尋

HOSPITAL-LEVEL VARIATIONS IN RATES OF INPATIENT URINARY TRACT INFECTION OCCURRENCE IN STROKE - AN ANGLIA STROKE CLINICAL NETWORK EVALUATION STUDY

出版	2017
URL	http://books.google.com.hk/books?id=P4C6zQEACAAJ&hl=&source=gbs_api

註釋Background Urinary tract infection (UTI) is one of the most common complications following stroke, and has been associated with a 14-fold increase in odds of poor functional outcome at discharge. UTI ratesu202fhave been shown tou202fvary between hospitals, although it is unclear whether this is due to case-mix differences or hospital-level heterogeneity in care.u202f Method Au202fprospective multi-centreu202fcohort study of acute stroke patients admitted tou202feight National Health Service hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009u202fand 2011u202fwas conducted.u202fWeu202fmodelled the association between hospital (as a fixed-effect) and inpatient UTI using a multiple logistic regression model adjusting foru202festablished patient-level risk factors. We descriptively analysed variations in UTI in relation to heterogeneities in hospital-level characteristics.u202fu202f Results Out of 2241 stroke admissions, 171 (7.6%) acquired inpatient UTI. UTI rates variedu202fsignificantlyu202fbetween the eight hospitals, ranging from 3% to 11%.u202fThe hospital that had the lowest odds of UTI (OR=0.50(0.22 to 1.11) in adjusted analysis, had the highest number of junior doctors and occupational therapists compared to all other hospitals. The hospital with the highest adjusted UTI rate (OR=2.69(1.56 to 4.63)) had the highest stroke volume, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner. Conclusion Our results highlight the potential influence of service characteristics on post-stroke UTI, independently of patient-level factors. This study informs policymakers that modifiable hospital factors, such as staffing and resources, could influence this complication and its associated effect on stroke outcomes.