Open AccessImpact of a learning health system on acute care and medical complications after intracerebral hemorrhage
Author(s) -
Matsumoto Koutarou,
Nohara Yasunobu,
Wakata Yoshifumi,
Yamashita Takanori,
Kozuma Yukio,
Sugeta Rui,
Yamakawa Miki,
Yamauchi Fumiko,
Miyashita Eri,
Takezaki Tatsuya,
Yamashiro Shigeo,
Nishi Toru,
Machida Jiro,
Soejima Hidehisa,
Kamouchi Masahiro,
Nakashima Naoki
Publication year - 2021
Publication title -
learning health systems
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.501
H-Index - 9
ISSN - 2379-6146
DOI - 10.1002/lrh2.10223
Subject(s) - medicine , intracerebral hemorrhage , stroke (engine) , odds ratio , confounding , confidence interval , incidence (geometry) , pneumonia , logistic regression , emergency medicine , intensive care medicine , subarachnoid hemorrhage , mechanical engineering , physics , optics , engineering
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.