Analysis of the active components of a complex intervention for the care management of stroke patients: impact on in-hospital mortality

We conducted a cohort observational study in 29 Italian hospitals to identify which factors of the acute care management process of ischemic stroke patient can reduce in-hospital mortality. This complex intervention is based on some potential organizational and clinical active components, so data are collected both at organizational unit and individual patient level. We built the variables in relation to presence/absence of clinical-demographic, care-process and organizational characteristics. We compared categorical variables and evaluated the studied independent variables effects on the in-hospital mortality risk at 7 and 30 days from admission. One of the main care success determinants is to be admitted in a stroke unit during the acute-stroke-phase. The most important organizational factor is to be short-time assessed by a stroke team: active role in patients' needs evaluation is provided by the stroke specialists' multidisciplinary team. Antithrombotic therapy is influencing mortality at 7 and 30 days likewise: it is a indispensable factor for the clinical protocols. Our study emphasizes the fact that higher access to different and integrated levels of organized care is associated to better stroke outcomes and that some active and interactive components of the patient's care management have to be identified in the complex intervention.