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Published on: January 15, 2017
Hospital admissions for stroke and bleeding in Hounslow following a quality improvement initiative
Kam Ying Wong1, Bethan Davies2, Yewande Adeleke1
1Department of Primary Care and Public Health, Imperial College London, London, UK.
Insights
The Hounslow atrial fibrillation (AF) quality improvement initiative showed a 17% decrease in stroke admissions. However, the study suggests this reduction may not be directly attributable to the initiative over time.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Atrial fibrillation (AF) is a prevalent arrhythmia, increasing stroke risk if undiagnosed or poorly managed.
- Quality improvement (QI) initiatives aim to enhance AF detection and anticoagulation, improving patient care.
- The Hounslow AF QI initiative focused on improving care for patients with AF.
Purpose of the Study:
- To evaluate the impact of the Hounslow AF QI initiative on stroke and bleeding admission rates.
- To assess changes in stroke and bleeding rates in the Hounslow population post-QI implementation.
Main Methods:
- Utilized hospital admissions data from January 2011 to August 2018.
- Employed interrupted time series analysis to examine standardized stroke and bleeding admission rates.
- Analyzed data before and after the QI initiative's start in October 2014.
Main Results:
- Observed a statistically significant 17% decrease in stroke admissions as a primary diagnosis (IRR 0.83, p<0.014).
- A non-significant decrease was noted for stroke admissions with AF as a secondary diagnosis (IRR 0.75, p<0.071).
- No significant changes were found in bleeding admission rates.
Conclusions:
- The observed reduction in stroke admissions may be linked to the AF QI initiative.
- However, the immediate level change and non-significant slope change suggest the intervention's long-term effect is uncertain.
- The decrease in stroke admissions might be influenced by other concurrent events or factors.
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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