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ID 115850
Author
Matsumoto, Koutarou Saiseikai Kumamoto Hospital|Kyushu University
Nohara, Yasunobu Kyushu University
Wakata, Yoshifumi Tokushima University
Yamashita, Takanori Kyushu University
Kozuma, Yukio Saiseikai Kumamoto Hospital
Sugeta, Rui Saiseikai Kumamoto Hospital
Yamakawa, Miki Saiseikai Kumamoto Hospital
Yamauchi, Fumiko Saiseikai Kumamoto Hospital
Miyashita, Eri Saiseikai Kumamoto Hospital
Takezaki, Tatsuya Kumamoto University
Yamashiro, Shigeo Saiseikai Kumamoto Hospital
Nishi, Toru Sakura Jyuji Hospital
Machida, Jiro Saiseikai Kumamoto Hospital
Soejima, Hidehisa Saiseikai Kumamoto Hospital
Kamouchi, Masahiro Kyushu University
Nakashima, Naoki Kyushu University
Keywords
learning health system
oral care
pneumonia
stroke
Content Type
Journal Article
Description
Introduction: Patients with stroke often experience pneumonia during the acute stage after stroke onset. Oral care may be effective in reducing the risk of stroke‐associated pneumonia (SAP). We aimed to determine the changes in oral care, as well as the incidence of SAP, in patients with intracerebral hemorrhage, following implementation of a learning health system in our hospital.
Methods: We retrospectively analyzed the data of 1716 patients with intracerebral hemorrhage who were hospitalized at a single stroke center in Japan between January 2012 and December 2018. Data were stratified on the basis of three periods of evolving oral care: period A, during which conventional, empirically driven oral care was provided (n = 725); period B, during which standardized oral care was introduced, with SAP prophylaxis based on known risk factors (n = 469); and period C, during which oral care was risk‐appropriate based on learning health system data (n = 522). Logistic regression analysis was performed to evaluate associations between each of the three treatment approaches and the risk of SAP.
Results: Among the included patients, the mean age was 71.3 ± 13.6 years; 52.6% of patients were men. During the course of each period, the frequency of oral care within 24 hours of admission increased (P < .001), as did the adherence rate to oral care ≥3 times per day (P < .001). After adjustment for confounding factors, a change in the risk of SAP was not observed in period B; however, the risk significantly decreased in period C (odds ratio 0.61; 95% confidence interval 0.43‐0.87) compared with period A. These associations were maintained for SAP diagnosed using strict clinical criteria or after exclusion of 174 patients who underwent neurosurgical treatment.
Conclusions: Risk‐appropriate care informed by the use of learning health system data could improve care and potentially reduce the risk of SAP in patients with intracerebral hemorrhage in the acute stage.
Journal Title
Learning Health Systems
ISSN
23796146
Publisher
University of Michigan|Wiley
Volume
5
Issue
2
Start Page
e10223
Published Date
2020-03-10
Rights
This is an open access article under the terms of the Creative Commons Attribution License(https://creativecommons.org/licenses/by/4.0/), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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language
eng
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departments
University Hospital