Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

Michelle Tornes; David J. McLernon; Max O. Bachmann; Stanley D. Musgrave; Elizabeth A. Warburton; John F. Potter; Phyo Kyaw Myint; On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

doi:10.3389/fneur.2019.00827

Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

Michelle Tornes^* (Corresponding Author), David J. McLernon, Max O. Bachmann, Stanley D. Musgrave, Elizabeth A. Warburton, John F. Potter, Phyo Kyaw Myint, On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

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 acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled 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 2241 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 to 1.11)) 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 to 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 address to improve the ultimate stroke outcome.

Original language	English
Article number	827
Journal	Frontiers in Neurology
Volume	10
DOIs	https://doi.org/10.3389/fneur.2019.00827
Publication status	Published - 6 Aug 2019

Bibliographical note

Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge.

Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

Keywords

stroke
health services resaerch
acute hospital
outcome
urinary tract infection (UTI)
MEDICAL COMPLICATIONS
MORTALITY
CHOLESTEROL
PNEUMONIA
health services research
IMPACT
PREDICTORS
acute hospitals
urinary tract infections
ACUTE ISCHEMIC-STROKE
COHORT
OUTCOMES
STAY
Acute hospitals
Stroke
Health services research
Outcome
Urinary tract infections

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10.3389/fneur.2019.00827Licence: CC BY

Tørnes_fneur_hospital_level_VOR
Copyright © 2019 Tørnes, McLernon, Bachmann, Musgrave, Warburton, Potter and Myint. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. https://creativecommons.org/licenses/by/4.0/
Final published version, 610 KBLicence: CC BY

https://www.frontiersin.org/articles/10.3389/fneur.2019.00827/full#supplementary-materialLicence: Unspecified

Cite this

@article{cd9563a8810049728a662b7cdb57befe,

title = "Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke",

abstract = "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 acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled 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 2241 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 to 1.11)) 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 to 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 address to improve the ultimate stroke outcome.",

keywords = "stroke, health services resaerch, acute hospital, outcome, urinary tract infection (UTI), MEDICAL COMPLICATIONS, MORTALITY, CHOLESTEROL, PNEUMONIA, health services research, IMPACT, PREDICTORS, acute hospitals, urinary tract infections, ACUTE ISCHEMIC-STROKE, COHORT, OUTCOMES, STAY, Acute hospitals, Stroke, Health services research, Outcome, Urinary tract infections",

author = "Michelle Tornes and McLernon, {David J.} and Bachmann, {Max O.} and Musgrave, {Stanley D.} and Warburton, {Elizabeth A.} and Potter, {John F.} and Myint, {Phyo Kyaw} and {On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group}",

note = "Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge. Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.",

year = "2019",

month = aug,

day = "6",

doi = "10.3389/fneur.2019.00827",

language = "English",

volume = "10",

journal = "Frontiers in Neurology",

issn = "1664-2295",

publisher = "Frontiers Media S.A.",

}

TY - JOUR

T1 - Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

AU - Tornes, Michelle

AU - McLernon, David J.

AU - Bachmann, Max O.

AU - Musgrave, Stanley D.

AU - Warburton, Elizabeth A.

AU - Potter, John F.

AU - Myint, Phyo Kyaw

AU - On behalf of the Anglia Stroke Clinical Network Evaluation Study (ASCNES) Group

N1 - Sources of Funding: MT holds a PhD studentship funded by the School of Medicine, Medical Sciences and Nutrition, University Aberdeen. The Anglia Stroke Clinical Network Evaluation Study (ASCNES) is funded by the National Institute for Health Research (NIHR) Research for Patient Benefit Programme (PB-PG-1208-18240). This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) programme (Grant Reference Number PB-PG-1208-18240). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. EW receives funding support from the NIHR Biomedical Research Centre award to Cambridge. Data Availability: The raw data supporting the conclusions of this manuscript will be made available by the authors, without undue reservation, to any qualified researcher.

PY - 2019/8/6

Y1 - 2019/8/6

N2 - 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 acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled 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 2241 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 to 1.11)) 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 to 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 address to improve the ultimate stroke outcome.

AB - 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 acute hospital trusts within the Anglia Stroke & Heart Clinical Network between 2009 and 2011 was conducted. We modelled 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 2241 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 to 1.11)) 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 to 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 address to improve the ultimate stroke outcome.

KW - stroke

KW - health services resaerch

KW - acute hospital

KW - outcome

KW - urinary tract infection (UTI)

KW - MEDICAL COMPLICATIONS

KW - MORTALITY

KW - CHOLESTEROL

KW - PNEUMONIA

KW - health services research

KW - IMPACT

KW - PREDICTORS

KW - acute hospitals

KW - urinary tract infections

KW - ACUTE ISCHEMIC-STROKE

KW - COHORT

KW - OUTCOMES

KW - STAY

KW - Acute hospitals

KW - Stroke

KW - Health services research

KW - Outcome

KW - Urinary tract infections

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U2 - 10.3389/fneur.2019.00827

DO - 10.3389/fneur.2019.00827

M3 - Article

C2 - 31447761

SN - 1664-2295

VL - 10

JO - Frontiers in Neurology

JF - Frontiers in Neurology

M1 - 827

ER -

Hospital-level Variations in Rates of Inpatient Urinary Tract Infections in Stroke

Abstract

Bibliographical note

Keywords

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