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dc.contributor.authorMuñoz Venturelli, P-
dc.contributor.authorLi, X-
dc.contributor.authorMiddleton, S-
dc.contributor.authorWatkins, C-
dc.contributor.authorLavados, PM-
dc.contributor.authorOlavarría, VV-
dc.contributor.authorBrunser, A-
dc.contributor.authorPontes-Neto, O-
dc.contributor.authorSantos, TEG-
dc.contributor.authorArima, H-
dc.contributor.authorBillot, L-
dc.contributor.authorHackett, ML-
dc.contributor.authorSong, L-
dc.contributor.authorRobinson, T-
dc.contributor.authorAnderson, CS-
dc.contributor.authorHEADPOST (Head Positioning in Acute Stroke Trial) Investigators-
dc.identifier.citationJournal of the American Heart Association, 2019, 8 (13), e012640en
dc.description.abstractBackground The uptake of proven stroke treatments varies widely. We aimed to determine the association of evidence-based processes of care for acute ischemic stroke ( AIS ) and clinical outcome of patients who participated in the HEADPOST (Head Positioning in Acute Stroke Trial), a multicenter cluster crossover trial of lying flat versus sitting up, head positioning in acute stroke. Methods and Results Use of 8 AIS processes of care were considered: reperfusion therapy in eligible patients; acute stroke unit care; antihypertensive, antiplatelet, statin, and anticoagulation for atrial fibrillation; dysphagia assessment; and physiotherapist review. Hierarchical, mixed, logistic regression models were performed to determine associations with good outcome (modified Rankin Scale scores 0-2) at 90 days, adjusted for patient and hospital variables. Among 9485 patients with AIS, implementation of all processes of care in eligible patients, or "defect-free" care, was associated with improved outcome (odds ratio, 1.40; 95% CI, 1.18-1.65) and better survival (odds ratio, 2.23; 95% CI , 1.62-3.09). Defect-free stroke care was also significantly associated with excellent outcome (modified Rankin Scale score 0-1) (odds ratio, 1.22; 95% CI , 1.04-1.43). No hospital characteristic was independently predictive of outcome. Only 1445 (15%) of eligible patients with AIS received all processes of care, with significant regional variations in overall and individual rates. Conclusions Use of evidence-based care is associated with improved clinical outcome in AIS . Strategies are required to address regional variation in the use of proven AIS treatments. Clinical Trial Registration URL : . Unique Identifier: NCT02162017.en
dc.description.sponsorshipThe study was supported by a project grant (1066966) from the National Health and Medical Research Council of Australia.en
dc.publisherWiley, American Heart Association: JAHA , American Stroke Associationen
dc.rightsCopyright © the authors, 2019. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License (, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.en
dc.subjectacute stroke careen
dc.subjectmultilevel analysisen
dc.titleImpact of Evidence-Based Stroke Care on Patient Outcomes: A Multilevel Analysis of an International Study.en
dc.typeJournal Articleen
dc.description.versionPublisher Versionen
dc.type.subtypeJournal Article-
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCESen
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicineen
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciencesen
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCES/Themesen
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCES/Themes/Cardiovascularen
pubs.organisational-group/Organisation/COLLEGE OF LIFE SCIENCES/Themes/Neuroscience & Behaviouren
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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