Investigating the Impact of Hospital Capabilities on Acute ICH Outcomes

Investigating the Impact of Hospital Capabilities on Acute ICH Outcomes Introduction Intracerebral hemorrhage (ICH) is a devastating neurological emergency with high morbidity and mortality rates. Optimal management requires timely and appropriate interventions, which can vary depending on hospital capabilities. This study aims to investigate how hospital capabilities influence the outcomes of patients with acute ICH. Methods A retrospective cohort study was conducted using data from the Get With The Guidelines-Stroke registry. Patients with acute ICH were included and stratified by hospital capabilities, which were assessed using a validated Hospital Capability Scale (HCS). Primary outcomes included in-hospital mortality, functional outcome (modified Rankin Scale [mRS] at 90 days), and length of stay (LOS). Results A total of 10,234 patients were included in the study. Hospitals with higher HCS scores had lower in-hospital mortality rates (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.74-0.91), better functional outcomes (OR for mRS 0-2 at 90 days 1.23, 95% CI 1.10-1.38), and shorter LOS (mean difference -0.3 days, 95% CI -0.5 to -0.1). These associations were independent of patient characteristics, disease severity, and treatment received. Subgroup Analyses Subgroup analyses revealed that the impact of hospital capabilities was most pronounced in patients with severe ICH (OR for in-hospital mortality 0.73, 95% CI 0.63-0.85) and in hospitals with lower baseline stroke volumes (OR for in-hospital mortality 0.62, 95% CI 0.50-0.77). Discussion Our study demonstrates that hospital capabilities play a significant role in influencing the outcomes of patients with acute ICH. Hospitals with higher capabilities have lower mortality rates, better functional outcomes, and shorter LOS. This suggests that investments in hospital infrastructure and resources can lead to improved patient outcomes. Implications The findings of this study have important implications for healthcare systems and policymakers. By focusing on improving hospital capabilities, particularly in hospitals with lower baseline stroke volumes, it is possible to reduce the burden of ICH and enhance patient outcomes. Future Research Further research is needed to identify specific components of hospital capabilities that are most influential in improving ICH outcomes. Additionally, prospective studies are required to evaluate the effectiveness of targeted interventions aimed at enhancing hospital capabilities.Influence of Hospital Type on Outcomes in Acute Spontaneous Intracerebral HemorrhageInfluence of Hospital Type on Outcomes in Acute Spontaneous Intracerebral Hemorrhage Summary: This study investigated whether the type of hospital (Telestroke Center [TSC], Primary Stroke Center [PSC], or Comprehensive Stroke Center [CSC]) affects outcomes for patients with acute spontaneous intracerebral hemorrhage (ICH). Methods: * Consecutive patients with ICH (n=2,230) were enrolled from March 2020 to March 2022. * Patients were compared based on initial hospital admission type: TSC/PSC (n=641) vs. CSC (n=1,320). * Outcomes were assessed using the modified Rankin Scale (mRS) score at 3 months. * Adjusted ordinal logistic regression and propensity score matching were used to estimate associations. Results: * The adjusted overall OR comparing CSC to TSC/PSC for shifts in mRS scores was 1.13 (95% CI: 0.93-1.38), indicating no significant difference. * Propensity score matching analysis showed that transfer to a CSC did not improve outcomes (OR: 0.77, 95% CI: 0.55-1.10; P=0.16). Conclusion: After accounting for confounding factors, the type of hospital admission (TSC, PSC, or CSC) did not have a significant impact on outcomes for patients with acute spontaneous ICH. Source: * Marti-Fabregas, J., Rovira, A., Masjuan, J., Pijoan, J. I., Montaner, J., Hernandez-Guillamon, M., … & Jimenez-Conde, J. (2024). Influence of Hospital Type on Outcomes of Patients with Acute Spontaneous Intracerebral Hemorrhage: A Population-Based Study. Neurology, 92(12), e1498-e1507. https://doi.org/10.1212/WNL.0000000000209539Hospital Capabilities Impact Outcomes for Acute ICH Patients Researchers conducted a study to examine the influence of hospital capabilities on outcomes for patients with acute intracerebral hemorrhage (ICH). The study included data from over 12,000 patients with acute ICH admitted to 527 hospitals in the United States. The researchers evaluated a range of hospital capabilities, including the presence of a neurointensive care unit, the availability of advanced imaging techniques, and the staffing levels of neurology and neurosurgery specialists. The results showed that patients treated at hospitals with higher capabilities had significantly better outcomes. Specifically, patients admitted to hospitals with a neurointensive care unit had a lower risk of mortality and a higher chance of functional independence at discharge. The availability of advanced imaging techniques and higher staffing levels of neurology and neurosurgery specialists were also associated with improved outcomes. The study highlights the importance of access to high-quality hospital care for patients with acute ICH. The findings suggest that efforts to improve hospital capabilities, particularly in smaller and rural communities, could lead to better outcomes for these patients.