Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke
Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospital...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-08-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2019.00827/full |
| _version_ | 1818267072482770944 |
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| author | Michelle Tørnes David J. McLernon Max O. Bachmann Stanley D. Musgrave Elizabeth A. Warburton John F. Potter John F. Potter Phyo Kyaw Myint Phyo Kyaw Myint |
| author_facet | Michelle Tørnes David J. McLernon Max O. Bachmann Stanley D. Musgrave Elizabeth A. Warburton John F. Potter John F. Potter Phyo Kyaw Myint Phyo Kyaw Myint |
| author_sort | Michelle Tørnes |
| collection | DOAJ |
| description | Background and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service (NHS) acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.Results: We included 2,241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3 to 11%. The hospital that had the lowest odds of UTI [odds ratio (OR) = 0.50 (95% confidence interval (CI) 0.22–.11)] in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate [OR=2.69 (1.56–4.64)] was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to be addressed to improve the ultimate stroke outcome. |
| first_indexed | 2024-12-12T20:16:47Z |
| format | Article |
| id | doaj.art-0fdc10c5988a412b9759654658330f0d |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-12T20:16:47Z |
| publishDate | 2019-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-0fdc10c5988a412b9759654658330f0d2022-12-22T00:13:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952019-08-011010.3389/fneur.2019.00827473662Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in StrokeMichelle Tørnes0David J. McLernon1Max O. Bachmann2Stanley D. Musgrave3Elizabeth A. Warburton4John F. Potter5John F. Potter6Phyo Kyaw Myint7Phyo Kyaw Myint8Ageing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United KingdomMedical Statistics Team, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United KingdomNorwich Medical School, University of East Anglia, Norwich, United KingdomNorwich Medical School, University of East Anglia, Norwich, United KingdomAddenbrooke's Hospital, Cambridge, United KingdomNorwich Medical School, University of East Anglia, Norwich, United KingdomStroke Research Group, Norfolk and Norwich University Hospital, Norwich, United KingdomAgeing Clinical and Experimental Research Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United KingdomStroke Research Group, Norfolk and Norwich University Hospital, Norwich, United KingdomBackground and purpose: Urinary tract infection (UTI) is one of the most common complications following stroke and has prognostic significance. UTI rates have been shown to vary between hospitals, but it is unclear whether this is due to case-mix differences or heterogeneities in care among hospitals.Methods: A prospective multi-center cohort study of acute stroke patients admitted to eight National Health Service (NHS) acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modeled the association between hospital (as a fixed-effect) and inpatient UTI using a multivariable logistic regression model, adjusting for established patient-level risk factors. We graphically and descriptively analyzed heterogeneities in hospital-level characteristics.Results: We included 2,241 stroke admissions in our analysis; 171 (7.6%) acquired UTI as an inpatient. UTI rates varied significantly between the eight hospitals, ranging from 3 to 11%. The hospital that had the lowest odds of UTI [odds ratio (OR) = 0.50 (95% confidence interval (CI) 0.22–.11)] in adjusted analysis, had the highest number of junior doctors and occupational therapists per five beds of all hospitals. The hospital with the highest adjusted UTI rate [OR=2.69 (1.56–4.64)] was tertiary, the largest and had the highest volume of stroke patients, lowest number of stroke unit beds per 100 admissions, and the highest number of hospital beds per CT scanner.Conclusions: There is hospital-level variation in post-stroke UTI. Our results suggest the potential influence of service characteristics independently of patient-level factors which may be amenable to be addressed to improve the ultimate stroke outcome.https://www.frontiersin.org/article/10.3389/fneur.2019.00827/fullstrokehealth services researchacute hospitalsoutcomeurinary tract infections |
| spellingShingle | Michelle Tørnes David J. McLernon Max O. Bachmann Stanley D. Musgrave Elizabeth A. Warburton John F. Potter John F. Potter Phyo Kyaw Myint Phyo Kyaw Myint Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke Frontiers in Neurology stroke health services research acute hospitals outcome urinary tract infections |
| title | Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke |
| title_full | Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke |
| title_fullStr | Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke |
| title_full_unstemmed | Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke |
| title_short | Hospital-Level Variations in Rates of Inpatient Urinary Tract Infections in Stroke |
| title_sort | hospital level variations in rates of inpatient urinary tract infections in stroke |
| topic | stroke health services research acute hospitals outcome urinary tract infections |
| url | https://www.frontiersin.org/article/10.3389/fneur.2019.00827/full |
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