The effects of a standardized nursing intervention model on immobile patients with stroke: a multicenter study in China

Abstract

Background: Immobility complications, including pressure injuries (PIs), deep vein thrombosis (DVT), pneumonia, and urinary tract infections (UTIs), affect the clinical outcomes of stroke patients. A standardized nursing intervention model (SNIM) was constructed and implemented to improve the quality of care and clinical outcomes among immobile patients with stroke. Aims: To assess the benefit of SNIM for immobility complication rates, including PIs, DVT, pneumonia, and UTIs, and mortalities in immobile patients with stroke. Methods: A before and after study design was used. Patients were divided into a pre- and post-SNIM training original cohort and matched for socioeconomic, demographic, and disease characteristics using propensity score. We fitted logistic regression models to examine the effect of SNIM, and whether the benefit differed between tertiary and non-tertiary hospitals. Results: In the original cohort, the rate of pneumonia, UTIs, and mortality was lower after SNIM training. Furthermore, in the matched cohort, the difference in PI rates was significant. Logistic regression analysis revealed that the probability of PIs, pneumonia, UTIs, and mortality were significantly reduced after SNIM training in the original cohort and this estimated value changed little in the matched cohort. Our results show that the decreased rates of pneumonia, UTIs, and mortality were mainly among non-tertiary hospitals. Conclusions: A structured and systematic SNIM benefited immobile stroke patients’ clinical outcomes, but mainly in non-tertiary hospitals in China. Standardized nursing training is needed in non-tertiary hospitals.

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study

“…Perhaps because the geriatric population in emergency departments are accompanied by immobility, failure to eat and drink, incontinence, and functional decline [38][39][40]. Older patients who are transferred from district hospitals or community hospitals probably only received basic inpatient services before [13], which may potentially increase the risk of poor ADL. Screening for ADL ability in emergency department patients and transferred patients are needed, which can inform prognosis and hospital services planning, target discharge planning, and post-discharge care.…”

“…In China, the hospital level is divided into three levels. Large-scale national, provincial, and municipal tertiary hospitals have more than 500 beds and can provide complex medical care services, whereas secondary county and district hospitals usually have 100-499 beds, which provide basic specialty care and inpatient services, while community hospitals provide preventive and primary care services with less than 100 beds [13,14]. The target population is all older patients in tertiary hospitals.…”

Hospitalization costs among immobile patients with hemorrhagic or ischemic stroke in China: a multicenter cross-sectional study

“…Subgroup analysis indicated that hospital level was highly correlated with the hospitalization costs for IHS. The potential reasons for this difference may be that hemorrhagic stroke is less prevalent but more likely to be fatal [26], and patients with more severe physical impairment definitely require more medical care resources [12,15,27]. Tertiary hospitals are top-level hospitals in China, in which the health services and medical resources are more advanced.…”

“…was designed by the research team and edited by the PowerPoint 2013, it was not taken from another source. Further information about the SNIM study has been published elsewhere [15]. Patients with stroke comprised 4716 patients with principal diagnosis codes I60.x, I61.x, H34.1, I63.x, I64.x, according to the International Classification of Diseases, Tenth Revision.…”

Propensity weighting: how to minimise comparative bias in non-randomised studies?

“…9 Recent examples in the European Journal of Cardiovascular Nursing in which propensity score matching has been used are the cohort study mentioned above in which hospital readmission rates were compared between patients attending cardiac rehabilitation and those who did not, 5 and a study on the effects of a standardised nursing intervention model on immobility in stroke survivors. 10 The main problem with propensity score matching is that researchers can seldom use their entire sample, because not all subjects of the control group have the characteristics to allow for the one-to-one paired propensity score matching without replacement. 11 Alternatives have been developed in which the full study population can be used, and thus efficiency of the study is gained compared with traditional propensity matching procedures.…”