Background and Purpose:
Poststroke
functional outcome is critical to stroke survivors. We sought to
determine whether adherence to current stroke performance measures is
associated with better functional outcome 90 days after an ischemic
stroke.
Methods:
Utilizing
the Brain Attack Surveillance in Corpus Christi cohort, we examined
adherence to 7 ischemic stroke performance measures from February 2009
to June 2012. Adherence to the measures was analyzed in aggregate using a
binary defect-free score and an opportunity score, representing the
proportion of eligible measures met. The opportunity score ranges from 0
to 1, with values closer to 1 implying better adherence. Functional
outcome, defined by an activities of daily living and instrumental
activities of daily living (ADL/IADL) score (range 1-4, higher scores
worse), was ascertained at 90 days poststroke. Tobit regression models
were fitted to examine the associations between the performance measures
and functional outcome, adjusting for demographic and clinical
characteristics, including stroke severity.
Results:
There
were 565 patients with ischemic stroke included in the analysis. The
median ADL/IADL score was 2.32 (interquartile range [IQR]: 1.41-3.41).
The median opportunity score was 1 (IQR: 0.8-1), and 58.4% of the
patients received defect-free care. After adjustment, the opportunity
score (
P = .67) and defect-free care (
P = .92) were not associated with functional outcome.
Conclusion:
In
this population, adherence to a composite of current stroke performance
measures was not associated with poststroke functional outcome after
adjustment for other factors. Performance measures that are associated
with improved functional outcome should be developed and incorporated
into stroke quality measures.
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